The news that modern oral contraceptives increase the chances of a fatal blood clot is hard to swallow. Women must be given the whole picture, writes Judy Johnson
This week the news broke that millions of women who are taking modern oral contraceptives could be at risk of life-threatening blood clots. Though the link between the pill and deep vein thromboses (DVT) is not a new one, the report comes as scientists discovered women on some of the most popular contraceptive pills are almost twice as likely to develop blood clots, compared with those taking older products.
Doctors have been told by Britain's drug watchdog, the Medicines and Healthcare Products Regulatory Agency (MHRA), to ensure patients are aware of the risks and well informed of the differences in medication before they prescribe combined hormonal contraceptives, and that 'careful consideration should be given to the individual woman’s current risk factors'.
The newer or 'third generation' pills such as Yasmin, Marvelon and Femodene have become more widely used as they have fewer side effects such as weight gain and headaches. The updated guidelines were prompted when a report in France found that out of 200 cases of serious blood clots per year caused by the pill between 2000 and 2011, 14 of the 20 resulting deaths each year were down to these newer versions of the combined contraceptives. This sparked the alarm and led to the MHRA's warning to doctors throughout Europe to be more vigilant when writing prescriptions (while over in France, doctors are strictly offering the newer pills to women who have tried older alternatives first).
The MHRA has emphasised that 'a woman who has been using her combined contraceptive without any problems does not need to stop using it'; the Europe-wide call is simply asking that women be fully informed of the risks and options, and regularly reassessed by their doctors.
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There's no doubt that awareness is key; but amid the terrifying headlines splashed across front pages telling women they could die, few stories mention the other effects of the varying contraceptive pills, let alone the relatively low risk of developing a blood clot. In fact, pregnancy itself actually poses a far greater risk of DVT than taking the pill.
The brand or type of pill women take can affect more than just her chances of falling pregnant. Certain brands can be prescribed for women suffering with acne, others help with particularly painful periods, and all are altering hormones, which can have a number of implications. Skin problems and hair health are just two of them, and while acne and hair loss are not life-threatening conditions, they are life-changing for some. Both are emotionally difficult to deal with and can have a profound effect on daily life, so must not be dismissed when considering the 'safe' brands to prescribe - which poses a problem if the now criticised modern pills are better suited.
The synthetic hormones in these pills can help or hinder such conditions, depending on the levels which vary from brand to brand; this is why it's vital that doctors consider the full picture and make their prescription based on a woman's individual risks and personal health.
Glenn Lyons , trichologist at the esteemed Philip Kingsley clinic in London, feels strongly that women need to be fully informed on all the pros and cons of contraceptive pills in relation to their personal health. The headlines may be muddying the names of the newer prescription products but the older generation pills are not without risk. "For women with a genetic predisposal to hair loss, first generation pills are the worst ones to be on," explains Glenn. "They can exacerbate acne, hair loss, even polycystic ovary syndrome; the newer tablets are actually a better option for women with these issues."
The pill won't cause hair loss, but for women who suffer from it due to a sensitivity to the male hormone, newer contraceptives are more suitable thanks to their lower levels of its synthetic counterpart. "The cheapest, older pills such as Microgynon have the highest levels of male hormone, therefore will exacerbate acne or hair loss in those who suffer from the conditions," explains Glenn. Worse still, many women - particularly those under 30 - might not yet realise they have this sensitivity (genetic hair loss is the leading cause of thinning hair among young women) and could end up on a pill that makes the problem worse before it's even diagnosed by a trichologist.
Dermatologist Dr Sam Bunting agrees that it is far more complex than the headlines suggest. "We know the combined oral contraceptive pill is associated with an increased risk of a clot forming in the veins and that this risk is higher with third generation pills," explains Sam. "But to put this risk in context, the absolute risk is actually smaller than that associated with pregnancy itself and, generally speaking, in young healthy women the risk is small. It's also highest in the first year of taking it, so longstanding users of the pill should bear this in mind." The skin expert also warns us not to take the news at face value - because everyone is different. "Every drug used in medicine should be subject to a risk/benefit analysis. The benefits of these newer generation pills can be highly significant, in terms of disabling issues like excess facial hair growth and acne - so each case needs to be judged individually after thorough discussion with their doctor."
As the MHRA's letter says, 'The benefits associated with using a CHC [combined hormonal contraceptive] far outweigh the risk of serious side effects in most women'. Caution must be taken, of course, but scaremongering based on one possible side effect is not helpful in what is such a complicated medical issue. As with any other prescription drug, the contraceptive pill chosen for a patient must take into consideration all risk factors that apply - not just the more extreme possibilities. Awareness should not be confined to the topics which create the biggest headlines; it's the medical professionals' job to offer the best advice for the woman before them, and it's our job as women and as the patient to ask questions if we’re unsure.
Need more information? Head to the MHRA website for more details about the pill: www.mhra.gov.uk
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