Birth Control Pills Increase Thromboembolism Risk in PCOS Women

This isn't news to some of you, but did you know that taking birth control pills for PCOS can increase the risk of blood clots, a few of which could result in a thromboembolism?

A thrombus is the formation of a blood clot. An embolism is an obstruction in a blood vessel due to a blood clot or other foreign matter that gets stuck while traveling through the bloodstream.  When you put those words together, you have a thromboembolism, which is an obstruction of a blood vessel by a blood clot that has become dislodged from another site in your circulation. When you have an obstruction, your blood can't circulate as well.

If you have an obstruction in a tiny capillary, you won't even notice. But what if you get an obstruction in a large blood vessel, like in your leg?  In this case, you have a medical problem because of that clot breaks loose and travels to your lungs and gets stuck there, you have a pulmonary embolism.

A pulmonary embolism is pretty serious because it impairs your lung function. Or if a clots travels to your brain, you have a cerebral embolism, i.e., a stroke.

Women with PCOS Have Twice the Risk

What does all this have to do with polycystic ovary syndrome and birth control pills? The University of Florida College of Pharmacy published a study recently of 87,012 women. They found "a 2-fold increased risk of venous thromboembolism among women with PCOS who were taking combined oral contraceptives and a 1.5-fold increased risk among women with PCOS not taking oral contraceptives".

In other words, among women taking combined birth control pills, those with PCOS have double the risk of thromboembolism compared to women who did not have this condition. Even the women with polycystic ovarian syndrome who were not on the pill, the risk was 1.5 times the rate of normal women.

This is not a condemnation of birth control pills, nor are you going to die tomorrow from a stroke. The Pill is handy for relieving symptoms such as acne and hirsutism in some women. And it gives you the feeling that you're having a "normal" cycle. That's the benefit. But there's also a possible risk when you start introducing synthetic hormones into your body for a long time.

Source: Bird ST et al, Risk of venous thromboembolism in women with polycystic ovary syndrome: a population-based matched cohort analysis. CMAJ. 2013 Feb 5;185(2):E115-20.

Low-Dose Contraceptives Increase Risk of Heart Attack and Stroke

A U.S.-Canadian study has found that even low-dose oral contraceptives appear to increase women's risk of a heart attack or stroke.

Dr. John Nestler and Dr. Paulina Essah of Virginia Commonwealth University and Dr. Jean-Patrice Baillargeon of the Universite de Sherbrooke analyzed the results of several studies published between 1980 and 2002. They determined that women using low-dose contraceptives have approximately twice the risk of stroke or heart disease.

Women with polycystic ovary syndrome or metabolic syndrome already have an increased risk of cardiovascular disease, Dr. Nestler said, and are at an even greater risk if they are treated with low-dose contraceptives. He suggested that doctors consider less risky alternatives. Long-term use of oral contraceptives may also increase risk, Nestler said. But he said that for most women the risk is still very low.

This study reinforces why we emphasize the importance of natural approaches for treating PCOS such as healthy diet, regular exercise, stress management, selected nutritional supplements and herbs. Hormone contraception is effective to prevent pregnancy but should be chosen with a full understanding of the health risks involved. Always consider contraceptive alternatives, including barrier methods like diaphragms, cervical caps, the intrauterine device and condoms, which have the added benefit of disease protection.

Source: Baillargeon, JP et al, Association between the current use of low-dose oral contraceptives and cardiovascular arterial disease: a meta-analysis. J Clin Endocrinol Metab. 2005 Jul;90(7):3863-70

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