Dr. Judith Simms-Cendan disproves common myths about the use of birth control pills
As an adolescent gynecologist, I prescribe birth control pills (BCPs) for a variety of reasons often unrelated to sexual activity, such as treatment of irregular, heavy or painful menses. I try to be very diligent about counseling about possible side effects such as headaches and nausea, or breakthrough bleeding, especially if they are not taken correctly. Also, some patients have real medical reasons why they should not take BCPs, usually because they have a reason why they cannot take estrogen. I routinely discuss the risks and benefits of taking any medication with my patients, but there is probably no medication that is surrounded by as many pre-conceived ideas as the birth control pill. In this blog, I’m going to address two of the most common fears of taking BCPs, and the good evidence that we have after 50 years of their use. Right up front, you should know that I receive no money, lunches, pens or any other form of incentive from any pharmaceutical company, and I am not invested in any pharmaceutical company, so there is no conflict of interest here.
Myth 1: I have a high risk of a blood clot if I take birth control pills.For years we have known that taking BCPs increases the risk of blood clots, but that increase is relatively very small. To have a better understanding, it is important to understand our risks from other activities; for example 1 in 5,000 of us will die from a car accident each year. In the United States the risk of dying in pregnancy is 1 in 8,700 pregnant women each year. Meanwhile the risk of death from BCPs in a non-smoker under the age of 35 is 1 in 1,667,000 (ibuprofen, acetaminophen are much riskier).
So does it mean when physicians refer to blood clots? These are venous thromboembolic events (VTEs), to use the medical term, and they occur when a blood clot forms in a woman’s vein, usually a leg vein. Usually a woman presents with swelling and pain below the level of the clot, usually in the lower leg. The danger is that the clot could move and travel to the lungs so it is important to treat one right away. The average risk of a blood clot without use of BCP for all reproductive age women not using any form of contraception is about 1 in 10,000 women, but risk goes up with age so that in young women the risk is much lower, and in women age 45 is 1 in 1,000. It is the estrogen in the pill that increases the risk of VTEs, and as estrogen levels are much lower now than they used to be, the risk has fallen from the 1960s, and is now about 7 in 10,000 women, less than half the risk of VTE in pregnancy, which is up to 3 in 1,000. For reasons that are unclear, it seems that BCPs like Yasmin that contain drospirenone increase the risk more than other pills, but the risk is still small overall. If you have a family history of blood clots, you may carry a gene that predisposes you to blood clots, so please tell your physician about who had the clot. Also if you have had a blood clot, you should not take BCPs. But the bottom line is that for most women, BCPs are very safe, and certainly lower risk than pregnancy.
Myth 2: I will get cancer if I take birth control pills.Ever since the results of the Women’s Health Initiative showed that hormone replacement therapy increased the risk of breast cancer, my patients have been afraid that BCPs will increase there risk of cancer. Here is the good news: Birth control pills LOWER the risk of ovarian cancer by 50% if taken for more than 5 years and uterine cancer, the most common female cancer, by 70% if taken for even one year. The risk of cervical and breast cancer detection is slightly higher in women currently taking the pill, probably because they are getting their mammograms and pap smears and the cancers have a chance to be detected. Ten years after discontinuation, the risk is the same as women who never used the pill. For women who have breast cancer, taking BCPs is not a good idea; but if a woman herself does not have cancer, only a family history of breast cancer or genes for breast cancer, she is not at higher risk for cancer if she takes BCPs.
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