Even among young women, the risk of blood clot should be a serious consideration if they are on hormonal birth control. Very recently, a friend of mine had a big scare. Her daughter Anne was complaining about unexplained lower back pain, and my friend found out that she was on birth control. She was especially concerned that Anne was on a version of birth control that had a similar formulation as Yaz (which contains ethinyl estradiol), the infamous pill that caused many cardio-vascular accidents among women, resulting in a class-action suit settlement of over 19,000 claims including 100 deaths. Putting the two together, my friend quickly ascertained that Anne may have a blood clot, and urged her to get tested for clots.
This mom, a faithful reader of our website, knew about the tragic stories of other young women like Alexandra Williams or Alex Rowan, whose early signs of blood clots, including lower back pain, were misread by medical professionals until it was too late.
Anne, a 28-year–old educated and active professional, was using this particular birth control pill in part because of its relieving effect on her acne. She had been to urgent care to check on her back pain, and the doctor had ruled out a blood clot. But upon learning the type of pill she was on, Anne’s mom insisted that she get it checked more thoroughly. Her daughter also complained about being short of breath, another serious sign of blood clots. Besides, members of the family had a history of blood clots and vascular disease. Now, where should she go to find out for sure?
The three levels of thorough testing for blood clots
Beyond an external checkup commonly performed by an outpatient physician (such as swollen and/or warm areas in the leg), the actual detection of a clot requires thorough testing, which is usually performed in an ER setting. Hospitals rely on three main tests to really find out if someone like Anne has a blood clot:
- The D-Dimer blood test
- The Doppler Ultrasound
- CAT Scan
D-Dimer blood test
The D-Dimer test is the first step of a thorough check for blood clots. It will effectively signal a blood clot risk, though it may not mean that you have a blood clot. D-dimers are protein fragments produced as the result of the dissolving of blood clots. Elevated D-dimer levels in your blood is a possible sign of blood clots, or a sign of elevated risk for clotting, but doesn’t show where the clot is.
Note that this test can be done by regular labs and is not expensive. The advantage of going to the ER is that the analysis is done on-site and results are produced within the hour. This can make the difference that saves a life and if you’re very concerned, it is worth doing.
Anne went to the ER to get checked. Her D-dimer test results were higher than normal. The ER physician immediately ordered the next two exams, which were performed one after the other within the next hour.
Doppler ultrasound
The next exam Anne underwent to rule out blood clots was a Doppler ultrasound. This exam is designed to check the blood circulation speed in the legs or the arms. It sends an ultrasound signal that bounces back off red blood cells. A Doppler ultrasound is non-invasive and painless. It can identify if there is a blockage or a clot.
CT Scan
The second exam, the CT Scan, is high precision imaging technology that will produce images of the veins and arteries and detect clots. Megan Henry, an Olympic athlete, was a young woman whose CT scan revealed a large number of clots around her lungs, an exam that saved her life. Note that the CT scan uses higher level radiation, which can have other side-effects.
Other tests for blood clots
Other possible tests include the ventilation/perfusion lung scan (“VQ scan”), which is a low-level radiation test reading a tracer injected in the patient’s veins, and a pulmonary angiogram, which is the most accurate but also the most risky. A MRI is also an option, and is usually administered to pregnant women for the safety of their baby.
Happily for Anne, both the Doppler ultrasound and CT scan were negative. She was able to go home safely, more aware of the signs of blood clots—and that her contraception method was a risk factor for her. What was next for her?
Preventing blood clots
As young women consider birth control options, they need to be thoroughly informed about the risk of vascular problems and the signs of blood clots. An estimated 300 to 400 young women die each year from blood clots caused by contraceptives, and 13,000 are hospitalized in the United States alone. Here are a few considerations for them.
Get tested for Factor V Leiden
At minimum, if a woman feels she must use contraceptive drugs, she should get tested for Factor V Leiden. Factor V Leiden is a genetic condition that greatly increases the risk of blood clots at any age. This condition can increase risk of VTE by 3 to 20 times. The blood test for Factor V Leiden is done by labs for patients who have a family history of blood clotting or show other risk factors. It is an expensive test ($180 to $280, but can be as high as $2,000) and not always covered by insurance (be sure to check). This doctor suggests that clinicians should “first order a test to measure the activated protein C (APC) resistance in the blood before the blood test.” However, this CDC article about the merits of conducting this test states that “women with Factor V Leiden (FVL) who take oral contraceptives are at higher risk for developing VTE and, if tested and found to have FVL, can be prescribed a more appropriate non-hormonal contraceptive.”
Learn fertility awareness methods (FAM) for safe family planning
The safest option, as even women without the Factor V Leiden condition are at an elevated risk for blood clots while on birth control, is to avoid hormonal contraception altogether. While non-hormonal, non-chemical options exist, such as condoms, diaphragms, and so on, the most effective family planning approach will be a well-understood and managed fertility awareness method (FAM) or natural family planning (NFP). The effectiveness rates of fertility awareness methods vary depending on the method, but they are very similar to the pill and free of side-effects.
Sometimes the challenge for potential users of fertility awareness is that it takes more learning and planning than just popping a pill. But the sad irony is that busy young women are often keen on carefully managing their diet and exercise, while at the same time daily ingesting a very powerful and dangerous drug out of ignorance of its side-effects and risks.
Two other factors may deter these young women from using a fertility awareness method: the possible lack of support from their partner, and the sense of uncertainty when using the method. We do recommend that a woman has a serious talk with her partner, which could actually be a test of commitment (“does he love me enough that he can take the change of birth control approach for the sake of my health?”). We also recommend that women and couples work with a professional teacher who can guide them through choosing the method that is best for their lifestyle and body, and help them gain confidence in reading the signs of their body for effective family planning.
Young women live busy lives. Regardless of their education level, managing partner relationships, work, career goals, and family plans is a lot to manage for anyone. In this context, it would seem that the birth control pill is a no-brainer, until they really understand the risks and side-effects to which they are subjecting themselves. A serious detection of any blood clot risk is critical if one has any doubt, followed by a pro-active search for good support and training in FAM.
If you’re a family member (especially a parent), this situation may trigger a range of feelings depending on your thoughts about birth control, from doubt and resistance if you believe that contraception is generally OK, to possible resentment if you’re strongly opposed to it. In any case, know that you can make a big difference and play an active role as you engage with your loved ones in a pro-active, non-judgmental and supportive way. A life may be at stake.
When this article refers to fertility awareness methods (FAM), or natural family planning (NFP), we are referring to Fertility Awareness-Based Methods, evidence-based methods of cycle charting which can be used as effective forms of natural birth control when learned by a certified instructor.
Additional Reading:
How A Blood Clot During Pregnancy Led Me to Fertility Awareness
Birth Control, Blood Clots, and the Untimely Death of Alexandra Williams
Blood Clots and Hormonal Birth Control
FDA Citizen’s Petition on Birth Control: Shocking Stories of How Women Are Getting Hurt
