From the Guidelines
Oral contraceptives carry several health risks, including blood clots, stroke, and heart attack, which can be life-threatening, and women should be aware of these risks before use, especially those with pre-existing medical conditions or risk factors such as smoking, high blood pressure, or a history of clotting disorders. The most serious risks associated with oral contraceptives include venous thromboembolism, which can lead to deep vein thrombosis, pulmonary embolism, stroke, or heart attack 1. These risks are higher in women who smoke, especially those over 35 years old, have high blood pressure, migraines with aura, or a personal history of clotting disorders. Combined hormonal contraceptives containing both estrogen and progestin pose greater clotting risks than progestin-only pills.
Some of the key health risks associated with oral contraceptives include:
- Blood clots (venous thromboembolism)
- Stroke
- Heart attack
- Breast cancer
- Cervical cancer
- Liver disease
- High blood pressure
- Migraines with aura
- Clotting disorders
According to a recent study, the risk of stroke is increased in oral contraceptive users, but the absolute increase in risk is small because of the low stroke incidence in this population 1. The increase in risk was present even with the newer low-dose estrogen preparations. Methodological limitations limited definitive conclusions regarding the impact of additional risk factors such as smoking, high blood pressure, and diabetes.
Women with certain medical conditions, such as uncontrolled hypertension, liver disease, certain types of migraines, or a history of hormone-sensitive cancers, should avoid combined oral contraceptives. The risks associated with oral contraceptives vary based on individual health factors, so consulting with a healthcare provider before starting oral contraceptives is essential to determine the most appropriate option 1. The healthcare provider can assess the safety of contraceptive method use for women with specific medical conditions or characteristics and provide guidance on the best course of action.
In terms of specific guidance, the U.S. Medical Eligibility Criteria for Contraceptive Use provides a framework for healthcare providers to assess the safety of contraceptive method use for women with specific medical conditions or characteristics 1. The criteria categorize conditions into four categories: Category 1 (no restrictions), Category 2 (generally can be used with careful follow-up), Category 3 (usually not recommended unless other methods are not available or acceptable), and Category 4 (unacceptable health risk).
Overall, while oral contraceptives can be an effective form of birth control, women should be aware of the potential health risks associated with their use and take steps to minimize these risks by consulting with a healthcare provider and following their recommendations.
From the FDA Drug Label
The use of oral contraceptives is associated with increased risks of several serious conditions including myocardial infarction, thromboembolism, stroke, hepatic neoplasia, and gallbladder disease, although the risk of serious morbidity or mortality is very small in healthy women without underlying risk factors An increased risk of thromboembolic and thrombotic disease associated with the use of oral contraceptives is well established The risk of thromboembolic disease associated with oral contraceptives is not related to length of use and disappears after pill use is stopped Several epidemiologic studies indicate that third generation oral contraceptives, including those containing desogestrel, are associated with a higher risk of venous thromboembolism than certain second generation oral contraceptives An increased risk of the following serious adverse reactions has been associated with the use of oral contraceptives: Thrombophlebitis and venous thrombosis with or without embolism, Arterial thromboembolism, Pulmonary embolism, Myocardial infarction, Cerebral hemorrhage, Cerebral thrombosis, Hypertension, Gallbladder disease, Hepatic adenomas or benign liver tumors
The health risks associated with oral contraceptives include:
- Thromboembolic events: such as deep vein thrombosis, pulmonary embolism, and stroke
- Myocardial infarction: increased risk of heart attack, particularly in smokers or women with underlying risk factors for coronary artery disease
- Cerebrovascular diseases: increased risk of thrombotic and hemorrhagic strokes, particularly in older women and those with hypertension
- Hypertension: increased risk of high blood pressure
- Gallbladder disease: increased risk of gallbladder disease and liver tumors
- Other risks: such as hepatic neoplasia, and an increased risk of adverse reactions including thrombophlebitis, arterial thromboembolism, and cerebral hemorrhage 2, 2, 2
From the Research
Health Risks Associated with Oral Contraceptives
The use of oral contraceptives has been linked to several health risks, including:
- Cardiovascular risks, such as coronary events, stroke, and deep vein thrombosis 3, 4, 5, 6, 7
- Increased risk of venous thromboembolism, particularly in carriers of the coagulation factor V Leiden mutation 5
- Arterial thrombosis, such as myocardial infarction or stroke, which may be directly related to estrogen dose, particularly in women who have hypertension, smoke, or are over 35 years old 5, 6
- Hypercoagulability, which can be counterbalanced by increased fibrinolytic activity 7
Risk Factors
Certain risk factors can increase the likelihood of health risks associated with oral contraceptives, including:
- Age over 35 3, 4, 6
- Smoking 3, 4, 6, 7
- Arterial hypertension 3, 6
- Obesity 3
- Family history of deep vein thrombosis 3
- Hereditary clotting disorders 3
- Hypercholesterolaemia exceeding 3 g/l 3
- Hypertriglyceridaemia exceeding 3 g/l 3
Reducing Risks
To reduce the risks associated with oral contraceptives:
- Use of oral contraceptives with very low doses of oestrogen (less than 50 mug ethinylestradiol) can reduce the associated risk of stroke 3
- Low-dose progestagen-only oral contraceptives have little effect on clotting factors or on carbohydrate and lipid metabolism 3
- History, physical examination, and simple laboratory tests before prescribing or renewing oral contraceptives can detect main contraindications 3
- Consideration of progestogen-only contraceptives in women with multiple cardiovascular risk factors 6