How Worried Should You Really Be About the Serious Health Risks Linked with Birth Control?
Hypochondriacs, take note.
Birth control is clearly a blessing, no debate there. It's certainly nice to have the freedom to get it on with worrying about getting pregnant. But a growing number of studies suggest those little pills–or that patch, ring, shot or IUD–may carry the risk of a slew of health problems that can be quite serious, including blood clotting, stroke and cancer. So we talked to experts to find out exactly what the dangers are, who is most at risk, and how to keep yours to a minimum.
But first, a quick primer: "There are two main types of hormonal contraceptives: those that contain estrogen and progesterone–such as the birth control pill, the NuvaRing and birth control patch–and those that contain only progesterone," like the progesterone-only pill, Depo Provera injection, and nexplanon implant, explains Raquel Dardik, MD, a clinical associate professor in the Department of Obstetrics and Gynecology of the Joan H. Tisch Center for Women's Health at NYU Langone Medical Center.
What Are the Risks?
Overall, serious risks related to hormonal birth control are rare, according to Jani R. Jensen, MD, an assistant professor of obstetrics and gynecology at the Mayo Clinic in Rochester, Minnesota. However, the risk for several conditions is slightly elevated, so they can't be written off entirely. "The risk of blood clots is increased in women who take hormonal contraceptives that contain estrogen, and in some cases, those containing certain types of progesterone like drospirenone," she says. "Hormone levels, particularly estrogen, may alter factors that affect how much blood clots."
Research published in 2015 in the British Medical Journal found that the risk of venous thromboembolism–a potentially fatal blood clot in a vein–was nearly three times higher in women who had had taken combined oral contraceptives than in those who had not. The diagnosis includes two conditions that are both life-threatening medical emergencies: One is deep vein thrombosis, which usually affects a vein in the lower leg or thigh and can block blood flow. Symptoms include red or warm skin, swelling, and leg pain or tenderness. The other type is pulmonary embolism, in which the deep vein thrombosis breaks off and travels to the lungs, blocking part or all of the blood supply the blood supply there. This can cause shortness of breath or rapid breathing, chest pain, rapid heart rate and lightheadedness or fainting.
However, it is important to keep the risk of clotting in perspective, says Jenson. While hormonal contraception may increase the risk of a clotting problem, it remains lower than the risk that occurs during pregnancy or just after it. "In the end, it seems that pregnancy always puts us at a higher risk, yet many women do not realize this," she says.
Researchers have also found slightly higher rates of heart attack and stroke, breast cancer,cervical cancer–even brain cancer– in women on hormonal birth control. On the other hand, the "risks of endometrial, ovarian and colon cancers have actually been shown to be reduced in women who take hormonal contraception," says Jenson. Some findings on the cancer link have been mixed, others have been based on high estrogen doses or very long-term use, and many more studies need to take place before firm conclusions can be made about any of these results.
Who Is Most at Risk?
"Additional risk factors for these events include obesity, tobacco use, high blood pressure and increasing age," says Dardik. Women older that 35, or with a history of blood clots in the legs or lungs, stroke, breast cancer or other conditions for which research findings have raised red flags "are not good candidates for estrogen-containing hormonal contraception," adds Jenson. Other conditions to be cautious about are autoimmune diseases like lupus, migraines with aura, and cirrhosis of the liver.
How to Reduce the Risks
"Obviously non-hormonal methods are also an option, but the inconvenience or risks make this unacceptable or undesirable for some women," Dardik says. Some options include the copper IUD and those old standbys: condoms and diaphragms.
"Steps that all women can take to minimize their risk while on hormonal contraceptives include discontinuing smoking, maintaining a healthy body weight, and minimizing other risk factors they may have," she advises. (If you need help kicking butts, find tons of free tools and tips at smokefree.gov and lung.org.)
If you are at risk of some of the problems associated with estrogen-containing birth control, a progesterone-only form might be a better bet. "As with any type of medication, contraceptives have risks and benefits," notes Dardik. "Since risk factors vary depending on additional risks and age, each person should individualize her care with a physician to weigh the risks of the medication with the potential benefits."
From: Womans Day
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