Last week it emerged that 14 women a year die in France as a result of taking certain contraceptive Pills. For the million-odd British women on them, it was worrying news.
Responding to this data, the medicines watchdog the Medicines and Healthcare products Regulatory Agency (MHRA) has urged all GPs to consider very carefully a woman's risk of blood clots before prescribing the contraceptive.
The Pill comes in many different forms and it is the third-generation Pills such as Yasmin and Marvelon that are deemed higher-risk and more likely to cause a blood clot.
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Third-generation Pills such as Yasmin and Marvelon are deemed higher-risk and more likely to cause a blood clot
The medicines contain man-made versions of the female hormones oestrogen and progesterone, and taking these in pill form suppresses a woman's natural menstrual cycle. But the oestrogen also increase the chance of developing a clot; the specific type of oestrogen in the third-generation Pills has been shown to convey double this risk.
Q. I've been on the Pill for years and vaguely remember the GP who prescribed it mentioning side effects - now I read there are deadly risks. Should I stop taking it?
A. This data concerns the Pills Marvelon, Yasmin and Femodene. The risks are increased on these but still remain very small in absolute terms for individuals.
Do not stop taking the Pill - the MHRA has advised this is not necessary. Speak to your doctor again about the risks, and if there are any concerns you should be switched to a different type or a different contraceptive altogether.
The women died from blood clots, which means either complications from a DVT or a stroke. These are known but uncommon consequences of being on the Pill.
What this French data highlights is that we have to convey these risks to patients and ensure women who are high-risk are not on these Pills.
Q. Who shouldn't be on the Pill?
A. There are certain absolute no-nos for the Pill, for example any woman known to have a clotting disorder, or hormonally driven illnesses such as migraine with aura or breast cancer.
For other risks such as weight, smoking or high blood pressure, it is more of a grey area and the GP and the patient weigh up those risks versus the benefits. For example, in a woman with a BMI over 30, the risks of a clot are higher but the advantages are thought to outweigh those risks. In these types of scenarios, the discussion with the patient is paramount, especially as there are alternative contraceptives.
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There are certain absolute no-nos for the Pill, for example any woman known to have a clotting disorder
A. At the outset you have a check-up usually three months after the Pill is initiated. After that you should be monitored at between six and 12 monthly appointments. The GP should be checking your blood pressure, asking you about side effects and making sure you are taking the medicine correctly.
They should also be checking to make sure you have not developed new risk factors. For instance, if a sibling developed a spontaneous blood clot, this increases your own likelihood of developing one on the Pill.
I do know some women decline their checks as they think they're fine, but in my practice we wouldn't issue the Pill to them.
Q. What other kinds of side effects should I be watching out for?
A. Contraceptive Pills are generally very well tolerated but they can cause weight gain, nausea, breast tenderness, mood swings and erratic bleeding. This usually settles down in the first few months, but if it doesn't there are many different types available and women tend to find one that will suit them.
Q. Can I just stop - or do I need to gradually reduce my dose?
A. If you are advised to stop, this would normally be done at the end of the month or cycle so as not to cause any disruption with your bleeding pattern. If you are suddenly deemed to be very high-risk, you can stop taking the Pill immediately: this would have no significant adverse effect.
Q. What are the alternatives?
A. As well as the commonly prescribed contraceptive Pills, there are also low-dose Pills that contain less oestrogen as well as mini-Pills (or Progesterone-only Pill) which contain no oestrogen. There are a whole range of non-Pill options known as LARCs - the long-acting reversible contraceptives that have the advantage of not relying on remembering to take a Pill, and no oestrogen, so no clot risk. These include the implant, the contraceptive injection and coils.
Read more: http://www.dailymail.co.uk/health/article-2554681/Weigh-risk-deadly-blood-clots-taking-Pill.html#ixzz2sqWn5bOz
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