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Blood Clots and Hormonal Birth Control

Blood clots are a hot topic this week. We asked our resident expert, Dr. Amy Roskin, what you need to know from a birth control perspective. As our Medical Director and Head of Clinical Operations, Dr. Roskin leads a team of nearly 100 licensed healthcare providers including physicians, nurse practitioners, and registered nurses to oversee 250k patient visits a year, supplying and serving hundreds of thousands of women nationwide.

Want to learn more? Take our health quiz and our medical team will provide you with a personalized option based on your medical history. And in the meantime, here's what Dr. Roskin has to say about how you should think about blood clots when it comes to hormonal birth control.

What are blood clots?

Blood clots are normally a sign that your body is doing its job. They form when certain parts of your blood thicken, forming a semisolid mass—a process, according to Mayo Clinic, that may be triggered by an injury. This is why you stop bleeding if you get a cut. There are also times where blood clots in ways or in places it's not supposed to. For example, the risk of blood clots is significantly greater during pregnancy than when on combined hormonal birth control.

What's the story with blood clots and contraception?

Here's what we know: blood clots are very rare and have always been a factor in contraception conversations. People on combined (estrogen-containing) hormonal birth control have a higher risk of blood clots than people who are not. We also know that birth control has become increasingly safe over time. This chart from the FDA illustrates risks across several factors. And it's worth nothing that risk changes with age (generally over 45), certain medical conditions (including pregnancy), and behaviors like smoking. That's why we always ask about these factors when partnering with patients to figure out the best birth control for them.

How do you and your team decide what birth control makes sense for a patient?

It all starts with your health history—that's why we ask about your blood pressure, smoking habits and nicotine usage, past history with birth control, allergies, past or family history of blood clots or clotting disorders, current medications and other questions that help your medical provider recommend the right option for you. If you decide you want to try birth control pills, your provider will first consider if the medication is safe for you. Overall, they'll want to prescribe the lowest dosage of hormones that will still be effective, while also considering other factors such as mitigating side effects, secondary benefits like treating acne, insurance coverage, affordability and additional health and lifestyle benefits (e.g., skipping periods). You can read more about how we prescribe here.

What should I watch out for if I'm nervous about blood clots?

The CDC has a great resource on identifying the risks, signs and symptoms associated with blood clots. When it comes to birth control, serious side effects are very rare but they can occur. You can read more about the side effects of birth control here.

What about non-hormonal birth control methods?

Blood clot risks are increased in contraceptives that use estrogen, which are called combined hormonal contraceptives. Hormonal methods that use progesterone only—such as a progesterone-only pill, IUD, injection like Depo-Provera, or arm implant like Nexplanon—do not have the same risks.

People seek out non-hormonal birth control for many reasons, and the method that’s right for you is the one that’s most effective and something you’re comfortable using and able to use every time you have sex.

There are several options ranging from the ones we know best like the male condom and copper IUD to newer options. Internal condoms like FC2 (which are available through the Pill Club) can be inserted hours before sex and are a great woman-controlled option to protect against sexually transmitted infections in addition to pregnancy. We break down the differences between these options
here.

What's your single piece of advice for someone trying to navigate tons of birth control options?

To know yourself. Think of medical appointments as a chance to learn; don't be shy about asking your provider questions. If you know what's normal for your body, then you'll be more likely to notice any changes

Consider using a calendar (we provide one here with our All Access guide) as a tool to keep track of your cycle and your body's day-to-day responses. Mobile apps can be helpful for this purpose, too.

It's very important to see a healthcare provider or a specialist for your annual physical exams. The Pill Club is in no way a substitute for your regular physical check-ups.

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