Many women worldwide take oral contraceptives (OCs) for birth control. OCs contain either one or both of these hormones: oestrogen and progestin.
OCs are widely adopted for their high efficacy (if taken correctly), low cost, overall safety and allows a complete return of fertility upon discontinuation of OCs.
Image credit: The Conversation
In general, OCs can be classified into three categories:
-
Combined oral contraceptive (COCs)
-
Progestin-only pills (POPs)
-
Emergency contraceptives/ ‘morning-after-pill’
COCs are more appealing than POPs because its regimen is less strict compared to POPs, which offer tremendous convenience for many women.
There are also different generations of COCs, which varied based on the types of progestin in the COCs.
Heart diseases? VTE?
Overall, OCs are relatively safe to use. However, some evidence suggests that taking OCs long-term may increase some undesirable health risks. OCs has been found to associated with increased risk of venous thromboembolism (VTE), i.e. the formation of blood clots in vein, stroke and heart attack. Formation of blood clots in the vein is a dangerous, as the blood clot can travel to your leg causing deep vein thrombosis, which can be very painful; or it can travel to your lung and cause pulmonary embolism, which results in difficulty in breathing, chest pain and reduce oxygen intake.
It’s worth noting that not all OCs have an equal risk of VTE and heart diseases. For instance, some evidence suggested that OCs containing drospirenone, a type of progestin, has a higher risk of VTE compared to other types of progestins. [1] Whereas OC that containing levonorgestrel has a significantly lower risk of VTE compared to those formulations with drospirenone, gestodene and desogestrel. [2,3]
On the other hand, the risk of heart attack or stroke was increased by 1.6 fold with the use of OCs. [4] The risk is largely attributed to the oestrogenic component of OCs, as the risk peaks if the oestrogen ingested is more than 50mcg. However, this is an unusual dose as most of the COCs in the market have oestrogen ranging from 20 - 30 mcg. Other factors such as smoking, existing hypertension and heart disease, age and migraine with aura can further increase the risk of the user.
Image credit: The Conversation
Context matters
Interestingly, the woman’s risk of VTE and heart disease would increase further if she were to become pregnant, have surgery, have a period of immobilisation or have cancer.[5] Although taking OCs can increase your risk of VTE and heart disease, but the absolute risk is still low. Talk to a doctor or pharmacist and he or she will help you to weigh the risk and benefits of taking OCs. [6]
Should I be worried?
It depends. Not all women who desired to take OCs are eligible for it. You are advised to talk to a doctor or pharmacist. Healthcare providers will evaluate your eligibility based on the WHO medical eligibility criteria (MEC) categories for contraceptive use. If you have been taking OCs for a while now, it’s also good that you talk to a healthcare provider to re-evaluate your eligibility.
If you’re not eligible, your healthcare provider will discuss other non-hormonal options with you.
Have any questions about contraception? Chat with our healthcare providers on Doc2Us® app today!
Download the Doc2Us® app on http://onelink.to/doc2us or use our web chat https://web.doc2us.com/
References:
-
Madigan D, Shin J. Drospirenone-containing oral contraceptives and venous thromboembolism: an analysis of the FAERS database. Open Access Journal of Contraception. 2018; Volume 9:29-32.
-
Lidegaard O, Lokkegaard E, Svendsen A, Agger C. Hormonal contraception and risk of venous thromboembolism: a national follow-up study. BMJ [Internet]. 2009 [cited 23 January 2020];339(aug13 2):b2890-b2890. Available from: http://10.1136/bmj.b2890
-
Van Hylckama Vlieg A, Helmerhorst F, Vandenbroucke J, Doggen C, Rosendaal F. The venous thrombotic risk of oral contraceptives, effects of oestrogen dose and progestogen type: results of the MEGA case-control study. BMJ [Internet]. 2009 [cited 23 January 2020];339(aug13 2):b2921-b2921. Available from:https://doi.org/10.1136/bmj.b2921
-
Carlton C, Banks M, Sundararajan S. Oral Contraceptives and Ischemic Stroke Risk. Stroke. 2018;49(4).
-
Eichinger S, Evers J, Glasier A, La Vecchia C, Martinelli I, Skouby S et al. Venous thromboembolism in women: a specific reproductive health risk. Human Reproduction Update. 2013;19(5):471-482.
-
Bateson D, Butcher B, Donovan C. Risk of venous thromboembolism in women taking the combined oral contraceptive: A systematic review and meta-analysis. Australian Family Physician [Internet]. 2016 [cited 6 April 2020];45(1):59-64. Available from: https://www.racgp.org.au/afp/2016/januaryfebruary/risk-of-venous-thromboembolism-in-women-taking-the-combined-oral-contraceptive-a-systematic-review-and-meta-analysis/
