From the Guidelines
It is strongly advised to avoid using the combined contraceptive pill for at least 4 weeks after recent surgery, especially if the procedure involved immobilization, due to the increased risk of venous thromboembolism 1. When considering the use of combined hormonal contraceptives after surgery, it's crucial to weigh the risks of venous thromboembolism against the benefits of contraception.
- The risk of blood clots is significantly increased when estrogen-containing contraceptives are used in conjunction with immobilization, such as during and after surgery.
- Alternative contraception methods, such as progestin-only pills, IUDs, or barrier methods, should be used during this period to minimize the risk of venous thromboembolism.
- If a woman has recently had surgery and is currently taking the combined pill, she should consult her healthcare provider immediately about whether to continue or switch to an alternative method temporarily.
- The U.S. Selected Practice Recommendations for Contraceptive Use, 2013, adapted from the World Health Organization, suggests that postpartum women with other risk factors for venous thromboembolism generally should not use combined hormonal contraceptives 3–6 weeks after delivery 1. Key considerations for healthcare providers include:
- Assessing the individual's risk factors for venous thromboembolism
- Providing alternative contraception options
- Educating patients on the importance of mobilization and other preventive measures to reduce the risk of blood clots
- Monitoring patients closely for signs and symptoms of venous thromboembolism after surgery.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Combined Contraceptive Pill and Recent Surgery
The use of combined contraceptive pills (CCPs) can increase the risk of venous thromboembolism (VTE), which is a concern for women who have recently undergone surgery 2, 3, 4, 5.
- The risk of VTE is dependent on both estrogen dose and type of progestin in CCPs 2.
- Transdermal patch and vaginal ring users have similar or higher VTE risk as combined oral contraceptive users 2.
- Progestin-only agents have varying VTE risk, with depot medroxyprogesterone acetate appearing to increase VTE risk, while the levonorgestrel-based intrauterine system and low-dose progestin-only pills have no additional VTE risk 2, 6.
- Newer generation formulations of hormonal contraceptives, as well as non-oral hormonal contraceptives, seem to be more thrombogenic than second generation hormonal contraceptives 3.
- The risk of VTE associated with CCPs can be mitigated by considering the type of progestin and estrogen dose, as well as the individual's medical history and risk factors 4, 5.
Thrombotic Risk and Contraceptive Choices
When considering contraceptive options, especially for women who have recently undergone surgery, it is essential to assess the individual's risk factors for VTE and choose a contraceptive method that minimizes this risk 5, 6.
- Women with a history of VTE and/or suffering from thrombophilia should be offered progestin-only contraceptives, such as oral desogestrel- or levonorgestrel-only contraceptives, intrauterine device, or etonogestrel implants, which are considered safe 5.
- Screening for thrombophilia is not indicated in every woman with the wish for contraception, but should be restricted to certain cases, such as women with a positive history for VTE or with close relatives suffering from VTE in younger than 50 years 5.