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How should you talk to your doctor about the risks?

Health watch

Study suggests new birth control pills are more likely to cause blood clots than older versions.

By Brigit Katz on June 4, 2015

According to a major study published in the British Medical Journal, newer forms of birth control pills can increase the chances of potentially fatal blood clots in the women who use them. The study posits that the risk is, in fact, between 1.5 and 1.8 times higher than with older versions of the pill. These seem like sobering statistics. But what do they mean?

The study’s findings concentrate on pills that contain a combination of estrogen and specific progesterone formulations: drospirenone, desogestrel, gestodene, and cyproterone. These iterations of the progesterone hormone are used in relatively recent generations of birth control pills, often referred to as “third generation pills.” When combined with estrogen, the new progesterones have been linked to higher incidences of blood clots. They continue to be prescribed, however, because they reduce unpleasant side effects associated with the pill, like weight gain, acne, and bleeding.

According to Dr. Taraneh Shirazian, an OBGYN at New York University’s Langone Medical Center, the BMJ study presents “very novel research, in the sense that it’s basically saying that all birth control pills don’t put you at the same risk of blood clots.” This is something that medical professionals already knew to be true about the new hormone drospirenone, which can be found in popular pills like Yaz and Yasmin. Pills with drospirenone are, in fact, marked with a special label that warns of increased clotting risks.

What should you do with this information? First of all, don’t panic. Any type of pill—whether new or old—poses a very small risk of blood clots. In fact, pregnancy is more likely to cause blood clots than any type of contraception. “We know that pregnancy in itself has the highest risk of thrombotic embolism,” explains Dr. Fahimeh Sasan, an OBGYN at Mount Sinai Hospital in New York. “Preventing an unintended pregnancy… is so beneficial that the small risk [of the pill] is always going to be outweighed.”

That doesn’t mean you should passively accept the prescription that your doctor hands to you at the end of your appointment. Asking questions about the pill can clue your doctor into your concerns, and help ensure that you are receiving the best form of birth control for your body. With that in mind, here is a guide—based on suggestions from Dr. Shirazian and Dr. Sasan—for talking to your doctor about finding the perfect contraception.

1. Make it clear why you want to obtain a prescription for the pill.

Birth control pills can serve more purposes than pregnancy prevention. Third generation pills are particularly effective at clearing up acne and mitigating acute severe mood changes during menstruation. For a woman who is simply looking for easily reversible contraception, the risks associated with newer forms of birth control might not be worthwhile.

“We put people on contraceptives for a variety of reasons,” Dr. Shirazian explains. “Talking to their doctor about the best personal, individualized methods for them is a really important piece of this.”

2. Ask your doctor if you are at risk for blood clots.

When you visit your gynecologist in search of a pill prescription, he or she will likely ask you a number of questions to determine clotting risks. Your age, lifestyle (smoking habits, in particular), and medical history will indicate whether or not you are an appropriate candidate for the pill. If you have any doubts, ask a pointed question.

“[Women] should talk about their history,” says Dr. Sharazien. “They should ask their doctor if she thinks or he thinks they have any predisposing factors, or any high risk factors for using a birth control pill.”

3. Ask your doctor to describe all viable birth control options, along with the risks and benefits of each one.

The pill is one of the most popular forms of contraception, but it is far from the only one. Your doctor can tell you about many other birth control options, including progesterone-only implants (which are inserted into the arm) and IUDs (which are inserted into the uterus). You can also discuss non-hormonal options, such as condoms and copper IUDs. Each one has its benefits and drawbacks, but all carry lower risks of clotting than the third generation pills.

“I have a lot of people come in and say ‘I’m here to get the pill,’ but they don’t really mean they want the pill,” says Dr. Sasan. “They just want birth control in general. The general rule with my patients is that I write down for them all of the options. When I start the conversation and people realize there are so many options, they might say something like, ‘Oh I actually hate taking pills. I would rather go a non pill-taking route.’”

4. If your doctor prescribes a birth control pill, make sure to ask: have you prescribed the lowest possible dose?

The quantity of hormones in a pill packet varies based on the prescription. If you experience side effects like breakthrough bleeding after beginning your pill cycle, a higher dosage may be necessary. But to start out, you want to obtain the lowest dose possible.

“I tend to put my patients on the lowest dose and then go from there,” says Dr. Sasan. “You generally don’t want to put [the patient], right off the bat, on a higher dose pill … [W]e know that [with] the higher the dose, maybe there are more complications.”

5. Get specific.

Feel free to ask your doctor why they have prescribed a particular pill brand for you. Though any good gynecologist will make meticulous considerations of risk factors before recommending a certain type of pill, you should feel comfortable knowing that you have received the safest prescription. If you are concerned about clotting, ask your doctor about the progesterone component of your pill, and why he or she thinks it does not pose a high risk.

“[Women] should talk about the nuances,” says Dr. Sharazian. “Everything has to be case specific, but I think it’s important for women to know this information, to know that all pills are not the same, and to ask these questions when they go to the office. If they haven’t chosen a pill yet … then I think it’s completely reasonable to choose one that has a progesterone that this [study] is saying is less likely to cause clots.”