Who Is Too Much At Risk To Take Birth Control Pills

Every woman who takes oral contraceptive pills has some risk of side effects and complications but the risks are generally regarded as very low for most women. For women with active estrogen-responsive cancers, such as breast cancer; or active liver disease, or actually pregnant, we say that the use of oral contraceptives is a Category 4: they should be avoided. However, there is a Category 3 that many women actually fit in to. We say that "the risks generally outweigh the benefits of the method" in Category 3 and we urge women to consider alternatives. For instance young women, ages 30-34,  with hypertension are 5-6 times greater to have a heart attack and stroke if they take birth control pills.  If you have been successfully using a birth control pill, but have one of these risk factors, most gynecologists will not automatically switch your method. It is important to put your risks in perspective. If you are not pregnant, you have a 1/10,000 risk of developing a blood clot in a deep leg vein. If you are pregnant the statistics are between 5-20/10,000. On low dose combination pills the risks are between the 1-5/10,000; on the Yaz pills or pills with drospirenone (a type of progesterone) and their cousins the risks are about 8-9/10,000. And in a study in Contraception September 2013 we have found that the Yasmin type pill (30 mcg of estrogen plus the 3 mg of the drospirenone) blood pressure didn't change but heart rate rose perhaps shedding new light on why the slightly greater risks. These topics are important to discuss with your gyno.. If you have health considerations a pregnancy can be more risky too, so in the gyno world they say weigh risks and benefits.
Here are some of the main groups of women who may be a Category 3 with respect to birth control pill use:

  • Smoking and age 35 years or older
  • Less than 21 days postpartum or 21–42 days postpartum with other risk factors
  • Major surgery with prolonged immobilization
  • History of deep vein thrombosis or pulmonary embolism
  • Hereditary thrombophilia (including antiphospholipid syndrome)
  • Inflammatory bowel disease with active or extensive disease, surgery, immobilization, corticosteroid use, vitamin deficiencies, or fluid depletion
  • Systemic lupus erythematosus with positive (or unknown) antiphospholipid antibodies


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