Hormonal contraceptives, or HC, were approved by the U.S. Food and Drug Administration in the 1960s, and have long been considered one of the most effective contraceptive methods on the market. Oral contraceptives, or OC, are known to have a failure rate of 2 to 3 percent with typical use. Along with OC, transdermal patches, injections, implants and vaginal suppositories have been developed as effective methods of hormonal birth control. According to a February 2010 article in the journal "Thrombosis Research," cases of blood clots have been reported to the FDA since the inception of hormonal contraceptives.
History
Contraceptives are widely used by women throughout the United States as an effective form of birth control. According to a 2010 article in the quarterly journal "Seminars in Reproductive Medicine," approximately 30 percent of sexually active women use some form of HC, while 82 percent of woman report that they have used HC sometime in their lifetime. It was initially thought that hormonal contraception had no effect on coagulation pathways, creating an environment prone to the development of blood clots. However, shortly after FDA approval, case reports of blood clots were reported, including fatal cases, as in a 2010 article in "Thrombosis Research." In a 2010 article in the journal "Clinical and Applied Thrombosis/Hemostasis," researchers conjecture that further studies are warranted to improve hormonal contraceptives, and to reduce and eliminate the risk of blood clots associated with HC use.
Function
Hormonal contraceptives work on the endocrine system by preventing ovulation, thickening cervical mucus and creating an environment within the uterus that is not conducive to implantation of a fertilized egg. Estrogen is the main component of hormonal contraceptives. High levels of estrogen are associated with blood clots, which also puts women at risk for heart attack and stroke. Since their development, researchers have improved hormonal contraceptives, lowering the amount of estrogen used, which has improved the overall risk of blood clots. However, there still remains a risk among hormonal contraceptive users, particularly in a subgroup of woman who are considered high risk.
Risk Factors
Health care providers recommend that all women be thoroughly screened for an increased risk of blood clots before starting a hormonal method of birth control. Women who have a prior history of blood clots or a family history of blood clots should consider alternative methods of birth control. In addition, the World Health Organization (WHO), discourages hormonal contraceptive use in women 35 years of age and older, who are obese, smoke, or have a history of diabetes.
Prevention/Solution
All women using hormonal contraceptives must be counseled on the increased risk of blood clots regardless of the route of administration, including oral, transdermal or injectable. Women need to be counseled to avoid smoking, maintain a healthy weight, remain physically active and continue with routine health screening.
Benefits/Further Research
Effective methods of birth control along with other benefits of hormonal contraceptive use, including reduction in pain associated with menstruation and protection against osteoporosis, are important benefits of hormonal contraceptive use. Therefore, providers must weigh the risk vs. the benefits when prescribing hormonal contraceptives to women. Although the risk of blood clots has considerable decreased since the creation of hormonal forms of birth control, scientists continue their research to develop safer forms of birth control.
References
- "Thrombosis Research;" Mechanisms of Estrogen-Induced Venous Thromboembolism; Svetlana N. Tchaikovski and Jan Rosing; February 2010
- "Seminars in Reproductive Medicine;" Recent innovations in oral contraception; Miriam Cremer, M.D., M.P.H., Scarlett Phan-Weston, and Adam Jacobs, MD; 2010
- "Expert Reviews: Cardiovascular Therapy;" Oral contraceptives and venous thromboembolism: identfying the safety option; Olivia Wu; 2010
- "Contraception;" Extended case-control study results on thromboembolic outcomes among transdermal contraceptive users; David D. Dore, Heather Norman, Jeanne Loughlin, and John D. Seeger; 2010
- "Journal of Family Planning and Reproductive Healthcare;" Risk of venous thromboembolism among users of oral contraceptives: a review of two recently published studies; Samuel Shapiro and Jurgen Dinger; 2010
- "Clinical and Applied Thrombosis/Hemostasis;" Risk factors for heart attack, stroke, and venous thrombosis associated with hormonal contraceptive use; Marina Y. Zakharova, Rachel M. Meyer, Kyle R. Brandy, Yvonne H. Datta, Marilyn S. Joseph, Pamela J. Shreiner, Gundo Rao, and Afshin Andre Divani; June 2010
