If you’ve ever experienced a heart palpitation, you know that the feeling of having a fast, fluttering, or pounding heart is scary, to say the least. But despite the freakiness, experts say heart palpitations happen pretty often—and they’re usually not dangerous or a sign of your impending doom.

“They’re very common,” Malissa Wood, M.D., co-director of the Corrigan Women’s Heart Health Program at Massachusetts General Hospital, tells SELF. “Most people will have palpitations at some point in their lives, even if are short-lived.” Nicole Weinberg, M.D., a cardiologist at Providence Saint John’s Health Center in Santa Monica, California, agrees, telling SELF that heart palpitations are “extremely common” in young women.

According to the Mayo Clinic, heart palpitations can feel like your heart is skipping beats, fluttering, beating too fast, or pumping harder than usual. “If you feel your heart beating at all, that can be a palpitation,” Wood explains. You might feel heart palpitations in your throat, neck, or chest, and they can occur when you’re active or resting, and whether you’re standing, sitting, or lying down, the Mayo Clinic says.

It’s not just a sensation that your heart is skipping beats or beating too fast—your heart is actually doing this, Weinberg says, noting that there can be several reasons for it. A major cause of heart palpitations in young women is having too much caffeine, she says. Wood agrees: “That second or third latte of the morning can bring out extra beats.”

Stress and anxiety are also big causes of heart palpitations, Wood says. “When your adrenaline level goes up, it makes you feel the palpitations because your heart is beating stronger or faster,” she explains. Lack of sleep can also be an issue, she says, adding that “all of the things that make you on edge can cause palpitations.”

Jennifer Haythe, M.D., assistant professor of medicine at Columbia University Medical Center, tells SELF that nicotine can also cause palpitations. “It’s a stimulant that can irritate the heart and cause extra beats,” she explains.

Hormones can play a role as well. That can be from taking new hormonal birth control pills, missing a menstrual cycle, or “any sort of hormonal changes,” Weinberg says. Pregnancy can also cause heart palpitations because your baseline heart rate increases in order to provide for you and the baby, Haythe says. “Even though there’s nothing wrong with you, you may feel a sense of palpitations,” she says.

Dietary changes can cause palpitations, too, Weinberg says, but it tends to be person-specific. “I do have some patients that say whenever they eat a lot of foods, like dairy or gluten, or when they’re not having their regular three meals a day…those are things that can bring on palpitations,” she says. Similarly, low blood sugar can give you heart palpitations, especially if you haven’t been eating enough but have been working out, Haythe says.

While Wood says heart palpitations are largely not dangerous, she points out that they can be caused by a thyroid condition, high electrolyte levels, or even heart disease in some cases. If you find that you’re having heart palpitations that last for several minutes at a time, you feel like you’re going to pass out when you have them, you experience them when you exercise, or you have chest pain or shortness of breath with palpitations, Wood says you need to get yourself checked out.

Weinberg agrees. “A few isolated palpitations are not a big deal, but if they’re associated with other symptoms or coming more frequently, that’s something that would be alarming,” she says. If you find that you get heart palpitations here and there with no other symptoms, Haythe says it’s a good idea to mention it to your doctor during your annual checkup. Your doctor may want to have you do a basic electrocardiogram, just to make sure everything is OK with your heart. “Take your symptoms seriously,” Haythe says. “But in the majority of cases, it’s nothing to worry about.”

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How Can It Raise Heart Risk?

You may hear your doctor call the pill “hormonal” birth control. As the name suggests, it’s got hormones in it, including estrogen and progestin. There are other methods to keep yourself from getting pregnant that also have them in it, like injections, IUDs (intrauterine devices), the patch, a device implanted under the skin called Nexplanon, and the vaginal ring.

Studies show the hormones in these kinds of birth control can affect your heart in many ways. They may raise your blood pressure, for instance. So if you take birth control pills, get your blood pressure checked every 6 months to make sure it stays in a healthy range. If you already have high blood pressure, talk with your doctor to see if another way to prevent pregnancy would be better for you.

Women who take certain birth control pills may see a change in some of their blood fats that play a role in heart disease. For example your levels of HDL “good” cholesterol could go down. At the same time, your triglycerides and LDL “bad” cholesterol may go up. This may cause a gradual buildup of a fatty substance called plaque inside your arteries. Over time, that can reduce or block the flow of blood to your heart and cause a heart attack or a type of chest pain called angina.

Estrogen in birth control pills can also raise your risk of blood clots.

Your chances of heart disease and other complications are higher if you:

  • Are older than 35
  • Have high blood pressure, diabetes, or high cholesterol
  • Smoke
  • Have ever had a stroke, heart attack, or blood clots
  • Get migraines with aura

PMC

A 35-year-old woman presented to the outpatient clinic with a 2-week history of episodic palpitations. She noted that each episode was abrupt in onset and would last approximately 1 to 2 hours before abating gradually. She denied chest pain, shortness of breath, and light-headedness and had no history of similar symptoms.

The patient’s medical and psychiatric history were unremarkable, and her only medication was an oral contraceptive (OC). She had been taking OCs since age 21 years and was currently taking 3 mg of drospirenone and 0.2 mg of ethinyl estradiol (Yasmin 28, Bayer Healthcare Pharmaceuticals, Wayne, NJ). The patient was a smoker and had smoked 1 pack of cigarettes per day since the age of 18 years. She denied alcohol or illegal drug use.

On examination, the patient appeared comfortable and in no distress. Vital signs were as follows: temperature, 36.8°C; blood pressure, 135/95 mm Hg; heart rate (HR), 102 beats/min and regular; respiratory rate (RR), 18 breaths/min; and oxygen saturation (Spo2), 91% while breathing room air. Cardiovascular examination revealed tachycardia but no murmurs, S3, or S4; jugular venous pressure was normal. Pulmonary examination showed clear lung fields and no signs of effusion. The patient had no goiter, palpable thyroid nodules, or asymmetry. Findings on examination of the skin, eyes, extremities, neurologic system, and peripheral arterial systems were normal.

  1. Which one of the following is the most likely etiology for the patient’s symptoms of palpitations?

    1. Thyrotoxicosis

    2. Anemia

    3. Anxiety disorder

    4. Nicotine use

    5. Arrhythmia

    Thyrotoxicosis (hyperthyroidism) will often manifest with alterations in cardiac physiology. Common signs include an increased heart rate, a widened pulse pressure, and an elevated systemic blood pressure. Atrial fibrillation, present in 10% to 20% of hyperthyroid patients, could lead to palpitations.1 However, in the absence of characteristic skin findings (diaphoretic and warm) and ocular signs (stare and lid lag), overt hyperthyroidism is less likely. In the setting of a significant anemia, palpitations can be perceived secondary to compensatory increases in HR and stroke volume in order to maintain adequate tissue oxygenation. In the absence of risk factors for bleeding, this would be uncommon.

    Psychiatric disorders can often coexist with somatic symptoms such as palpitations. In the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), palpitations are one of the multiple cardiopulmonary symptoms suggestive of a panic attack. However, in a retrospective study of 107 patients experiencing reentrant paroxysmal supraventricular tachycardia, approximately 70% fulfilled DSM-IV criteria for panic disorder as well.2 Although anxiety-related disorders are in the differential diagnosis for the patient’s symptoms, it would be premature to accept this as the sole etiology, especially without the usual accompanying symptoms and before further diagnostics. Although substances such as nicotine that increase adrenergic tone or diminish vagal activity could be a cause of palpitations, such palpitations would not usually present acutely and intermittently if the substances had been used long-term, as they were in this patient.

    Arrhythmias are a common cause of palpitations. The etiology can vary from benign premature atrial ectopic activity to more worrisome ventricular arrhythmias. Given the abrupt onset, persistence of symptoms, and the lack of previous psychiatric disease, an underlying cardiac process is the most likely etiology.

    A sinus tachycardia of 106 beats/min was evident on electrocardiography. A Holter monitor showed multiple episodes of sinus tachycardia (HR, 100-140 beats/min) of 1 to 2 hours in duration in concordance with palpitations. At follow-up 5 days later, the patient continued to report persistent symptoms. Vital signs were as follows: temperature, 36.7°C; blood pressure, 130/80 mm Hg; HR, 112 beats/min; RR, 30 breaths/min, and Spo2, 89% while breathing room air. Examination revealed tachycardia and tachypnea, without accessory muscle use, but findings were otherwise normal. Chest radiographic findings were normal.

    Laboratory studies revealed a hemoglobin of 13.3 g/dL (reference ranges provided parenthetically) (12.0-15.5 g/dL) and a thyroid-stimulating hormone level of 1.4 mIU/L (0.3-5.0 mIU/L).

  2. Given the case information up to this point, which one of the following is the most likely precipitant of this patient’s sinus tachycardia?

    1. Chronic nonparoxysmal sinus tachycardia

    2. Anxiety

    3. Pulmonary embolism (PE)

    4. Pheochromocytoma

    5. Postural orthostatic tachycardia syndrome

    Chronic nonparoxysmal sinus tachycardia is a rare form of supraventricular tachycardia, the mechanism of which is not fully understood. It is a diagnosis of exclusion and is characterized by varying degrees of automaticity and autonomic control. The clinical presentation can range from minimally symptomatic infrequent palpitations to symptomatic chronic tachycardia. However, it would not cause hypoxemia. Anxiety, although associated with sinus tachycardia and tachypnea, would also not cause hypoxemia.

    Pulmonary embolism involves obstruction of the pulmonary artery by a thrombus, fat, air, or a tumor that originates from elsewhere in the body. Thromboembolic disease is the most common form and is associated with variable signs and symptoms. Given the presence of tachypnea and hypoxemia, PE is the most likely precipitant of this patient’s sinus tachycardia.

    Pheochromocytomas are rare catecholamine-secreting tumors that are classically associated with the triad of episodic headaches, diaphoresis, and tachycardia. Hypertension, not present in this patient, is the most common finding. Hypoxemia is not associated with this condition.

    Postural orthostatic tachycardia syndrome is an entity characterized by inappropriate tachycardia in response to postural change. It is most prevalent in younger female patients. Symptoms include weakness, dizziness, visual symptoms, palpitations, and (rarely) syncope upon standing. This patient had no postural component to her symptoms.

    Because of the concern for PE, spiral computed tomography of the chest with intravenous contrast medium was performed and showed small, acute-appearing, subsegmental PEs in the posterior basal segments of the lower lobes bilaterally with associated peripheral infarction and hemorrhage.

  3. Which one of the following is the most appropriate next step in the management of this patient’s condition?

    1. Inpatient admission and administration of thrombolytic therapy

    2. Outpatient administration of low-molecular-weight heparin (LMWH) as bridge to warfarin

    3. Inpatient admission and administration of intravenous unfractionated heparin (UFH) as bridge to warfarin

    4. Inpatient admission and administration of LMWH as bridge to warfarin

    5. Inpatient admission and administration of LMWH without warfarin

    Thrombolytic therapies are potentially life-saving treatments for PE reserved for hemodynamically unstable patients presenting with sustained hypotension and cardiogenic shock. Such was not the case in our patient.

    No clear evidence-based guidelines are available for inpatient vs outpatient treatment of acute PE.3 However, multiple prognostic prediction rules help stratify patients’ risk of death, recurrent venous thromboembolism (VTE), and bleeding described in patients with acute symptomatic PE.4 Common variables to these risk scores are age, comorbid conditions, and hemodynamic abnormalities. The patient’s resting hypoxemia (Spo2, ≤90%), tachycardia (HR, ≥110 beats/min), and tachypnea (RR, ≥30 breaths/min) are suggestive of substantial hemodynamic strain. Therefore, outpatient management of this patient would be less than ideal.

    The initial treatment for this patient with objectively confirmed PE is a parenteral antithrombotic agent concomitantly with a vitamin K antagonist. The choice of antithrombotic agent should be individualized. For submassive PE, treatment with LMWH has been shown to be as safe and effective as intravenous UFH.5 Given its superior convenience and lower risk of heparin-induced thrombocytopenia, LMWH would be favored over UFH for this patient. Intravenous UFH is preferred in morbidly obese patients, in whom inadequate subcutaneous absorption is a concern, and in patients with renal failure, in whom decreased clearance of LMWH can increase the risk of hemorrhage. Unfractionated heparin is also preferred in patients at high risk of hemorrhage or if invasive procedures are likely because intravenous UFH can be stopped more quickly and reversed more reliably with protamine than LMWH.

    Warfarin decreases carboxylation of factors II, VII, IX, and X as well as proteins C and S by competitively inhibiting vitamin K epoxide reductase. This leads to decreased initiation of the coagulation pathways and aids in preventing further thrombotic events. In patients with acute PE, warfarin should be initiated on the first day of antithrombotic treatment and overlap (bridge) with LMWH or UFH for at least 5 days or until 24 hours after the international normalized ratio (INR) has reached the therapeutic range (INR, 2.0-3.0). The utility of bridging is 3-fold. First, warfarin inhibits only the new synthesis of vitamin K–dependent factors, and therefore preexisting clotting factors require 36 to 72 hours to clear from the circulation. Second, during the first 2 to 3 days of therapy with warfarin, the elevated prothrombin time reflects depletion of factor VII, which has a short half-life (5 to 7 hours); however, it does not reflect adequate anticoagulation because of incomplete suppression of the intrinsic coagulation pathway. Finally, rapid reduction of protein C, an endogenous anticoagulant with a short half-life (6 to 8 hours), can yield a transient hypercoagulable state, potentially leading to increased clot burden and, rarely, warfarin-induced skin necrosis.

    In patients with known malignancy and VTE, LMWH alone has been shown to decrease recurrent VTE and potentially improve survival compared with warfarin.6 This patient had no evidence of malignancy; therefore, monotherapy with LMWH would not be justified.

    The patient was admitted to the hospital, and LMWH and warfarin were initiated. On day 3 of the hospitalization, the patient’s hemodynamics normalized. Her medications included 10,000 U (200 U/kg) of dalteparin subcutaneously once daily and 5 mg of warfarin orally once daily. Her INR was 2.0 (0.9-1.2).

  4. Which one of the following tests would be the least helpful if the patient was evaluated for thrombophilia at this time?

    1. Functional assay of protein C

    2. Factor V Leiden gene mutation

    3. Anticardiolipin antibodies, IgG, and IgM

    4. Prothrombin (G20210A) gene mutation

    5. Total plasma homocysteine level

    Protein C is a naturally occurring vitamin K–dependent anticoagulant. Deficiency of this protein leads to a hypercoagulable condition that is associated with warfarin-induced skin necrosis. Measurement of protein C activity alone cannot be reliably interpreted in the presence of warfarin or liver disease, both of which lead to decreased hepatic synthesis of protein C. However, protein C activity can be checked concomitantly with factor VII activity, which has a similar half-life. If both are proportionally depressed, then the reduced activity of protein C is attributable to warfarin. If protein C activity is disproportionately reduced, a congenital deficiency cannot be excluded. Checking protein C activity alone would be the least helpful test at this time.

    Factor V Leiden is the most common genetic risk factor for VTE and is present in approximately 20% of patients with a first-time thromboembolic event.7 A point mutation, known as factor V Leiden, in the factor V gene results in resistance to degradation by activated protein C and leads to thrombosis. Factor V Leiden testing by polymerase chain reaction is not subject to interference by warfarin. The antiphospholipid syndrome is defined by the presence of at least 1 antiphospholipid antibody in the setting of arterial or venous thrombosis, thrombocytopenia, or recurrent miscarriages. Anticardiolipin or β2-glycoprotein-I antibodies can be present in the serum of patients with antiphospholipid syndrome and are not affected by the presence of acute thrombosis, warfarin, or LMWH. Hypercoagulability can result from a transition mutation in the prothrombin gene that is associated with increased plasma levels of prothrombin. Prothrombin gene mutation testing via a polymerase chain reaction–based assay is not subject to interference by warfarin. Elevated levels of homocysteine increase (relative risk, 2.5) the risk of arterial and venous thrombosis and are present in approximately 20% of patients with an initial VTE.7 Hyperhomocysteinemia is heritable but can be secondary to nutritional deficiencies, renal failure, hypothyroidism, and oral contraceptive (OC) use; warfarin does not affect testing.

    The patient’s PE was thought to be provoked by exogenous estrogen in the setting of tobacco use. Before her presentation, the patient was unaware of the risk of VTE with concomitant use of exogenous estrogen and tobacco. The patient was counseled on these risk factors and was agreeable to cessation of tobacco use but declined alternative contraceptive methods and intended to continue OC pills. It was thought to be appropriate, due to teratogenicity, to continue the OC pills for the duration of warfarin therapy and reconsider their use at follow-up.

    The patient was successfully bridged to warfarin. At 3 months follow-up, her palpitations and tachycardia had resolved. Warfarin was discontinued. The patient declined alternative contraceptive methods.

  5. Which one of the following oral contraceptives would be most reasonable to consider in the long-term management of this patient?

    1. Norethindrone (1 mg) plus mestranol (0.05 mg) (Ortho Novum 28, Ortho-McNeil Pharmaceuticals, Raritan, NJ)

    2. Levonorgestrel (0.1 mg) plus ethinyl estradiol (0.02 mg) (Aviane21, Duramed Pharmaceuticals, Cincinnati, OH)

    3. Drospirenone (3 mg) plus ethinyl estradiol (0.02 mg) (Yaz, Bayer Healthcare Pharmaceuticals, Wayne, NJ)

    4. Norethindrone (0.5 mg) plus ethinyl estradiol (0.035 mg) (Brevicon, Watson Pharmaceuticals, Salt Lake City, UT)

    5. Norethindrone (0.35 mg) (Micronor/Nor-QD, Watson Pharmaceuticals, Salt Lake City, UT)

Mestranol, the 3-methyl ether of ethinyl estradiol, is used in first-generation formulations of combination (estrogen-progestogen) OC pills. The dose of estrogen as well as the type of progestogen influences the rate of VTE. However, absolute contraindications to any OC containing estrogen (eg, mestranol or ethinyl estradiol) include a previous thromboembolic event, undiagnosed uterine bleeding, active liver disease, and a history of an estrogen-dependent tumor. Therefore, a combination OC pill containing mestranol would not be appropriate in this patient with a history of VTE.

Levonorgestrel is a second-generation progestogen used in combination OC pills as well as in the progestogen-releasing intrauterine device, Mirena (Bayer Healthcare Pharmaceuticals, Wayne, NJ). Because of the presence of ethinyl estradiol, this combination OC pill would be inappropriate. Drospirenone is a spironolactone analogue that has progestogenic, antimineralocorticoid, and antiandrogenic activity. Because of the latter 2 properties, it is associated with less weight gain and reduced hirsutism, respectively. However, the presence of ethinyl estradiol precludes its use in this patient.

Norethindrone is a progestogen used in combination OC pills as well as in progestogen-only contraceptive pills. Although this remains controversial, progestogen-only contraceptive pills have not convincingly been shown to be an independent risk factor for VTE.8-11 Therefore, norethindrone without ethinyl estradiol would be the preferred OC pill in this patient.

The patient returned to the clinic 1 year after the completion of her anticoagulation. She had discontinued tobacco use and had experienced no episodes of recurrent VTE.

What Every Woman Needs to Know About Blood Clots

by Varci Vartanian – Reproduced with Permission – Originally Published in the Daily Muse April 8, 2012

Kate, a 28-year-old development professional, was uploading snapshots of Mai Tais and Maui sunsets from her Hawaiian honeymoon when she noticed a pain in her calf that felt like a pulled muscle. At night, the pain was so intense that it woke her up, so she went to an orthopedic surgeon who ordered a scan.

The test didn’t show any issues, so she forgot about it, until seven months later, when the newlyweds hopped a plane to San Francisco. On the return layover, Kate exited the plane, felt dizzy, and passed out in the terminal. The alarmed couple rented a car and drove back home to North Carolina, where she saw a doctor again. He chalked it up to dehydration.

Then Kate started experiencing something new on her daily five-mile walks: “I was kind of short of breath. Since it was my first summer in North Carolina, I thought it was allergies or maybe that I was out of shape—so I would go extra hard on the elliptical machine.” She didn’t share her symptom with anyone and soon became preoccupied with packing for a family trip to Alaska and Seattle.

As she waved hello to Starbucks’ stomping grounds from the Space Needle, Kate was completely unaware of the killer in her right calf. A massive blood clot, or deep vein thrombosis (DVT), had formed in her lower right leg and was releasing smaller clots that were traveling to her lungs.

These blood clots in the lungs, called pulmonary emboli (PE), “can be life-threatening and in 10-15% of cases, cause sudden death,” says Dr. Jack Ansell, MD, hematologist and member of the National Blood Clot Alliance’s Medical & Scientific Advisory Board. “The first sign of a PE can be death.”

As the trip progressed, Kate had an increasingly difficult time catching her breath. She couldn’t shake the feeling “that something was wrong,” but boarded the plane with a pack of M&M’s and told herself everything would be OK.

Mid-flight, she got up to use the bathroom and collapsed in the middle of the aisle. A group of firemen on board gave her oxygen, and upon landing, an ambulance whisked her to an Atlanta ER where she was diagnosed with dehydration and vasovagal reaction (a fainting episode). She immediately flew back to North Carolina and scheduled an urgent doctor visit. As she prepped for her appointment, she collapsed again after climbing the stairs.

“I called 911, and the didn’t think anything major had happened,” she recalls. “They said, ‘wait until your husband gets home and he can take you to the doctor.’”

Luckily for Kate, a mother’s instinct was on her side. Her mom (a nurse) suggested that a blood clot might explain Kate’s mystery malady. Her doctor ordered a V-Q scan (a specialized lung test), and found multiple PEs in both lungs. Kate—a healthy young woman whose only risk factors were a series of flights longer than five hours and the daily birth control pill she popped—was in danger of having a heart attack.

Although Dr. Ansell states that the actual frequency of DVTs is low in young people, he emphasizes that it’s essential to know about the risk. “This should not be called an epidemic, but about 100,000 people die each year as a result and there are upwards of 500,000-600,000 cases per year.”

Take a lesson from Kate’s story, and read on for what you need to know.

Acquaint Yourself With the Symptoms

Kate was lucky to escape with her life, but knowing the warning signs could have gotten her more immediate medical attention. Shortness of breath, chest pain (particularly with deep breathing), coughing up blood, persistent leg pain, or redness, swelling, or warmth in your lower legs (usually one-sided) can all be indications of a blood clot in the legs or lungs, and should never be ignored.

And, give yourself a break already. “Women tend to beat themselves up about losing weight,” she says. “But, if you’re short of breath, it may not mean you’re out of shape. Know the signs and symptoms—you are your own best advocate.”

Get to Know Your Meds (and Your Family History)

Using estrogen-based birth control (pills, patches, and rings) comes with a risk of blood clots, though it’s relatively small. “The overwhelming majority of women on birth control pills do not have problems,” says Ansell.

But, it’s important to note that smoking, being obese, or having a family history of clotting disorders while you’re taking estrogen can all increase the risk.

Check your family tree for clotting disorders before your next appointment for hormonal birth control—and communicate the findings with your doctor. The most common inherited disorder leading to blood clots is Factor V Leiden, which is typically suspected in “individuals who develop blood clots at a young age, who are white with European ancestry, have a family history of clots, or have blood clots in unusual sites,” says Ansell.

If you’re already on estrogen-based birth control, burn the list of DVT and PE symptoms into your brain. And if you feel strongly that something is amiss—trust your instincts and see your doctor.

Wiggle Your Way Across the Ocean

Those warnings you see in the back of airline magazines? They do warrant a few seconds of your attention. “Individuals who undertake long distance air travel (greater than five hours) and are relatively immobile have a slightly greater chance of developing a clot,” says Ansell. And, the possibility of travel-related DVT is amplified somewhat with pre-existing factors (like taking estrogen-containing birth control, pregnancy, or obesity)—however, it’s important to note that the overall risk of clotting with air travel still remains small.

Even so, if you’re traveling internationally or cross-country, it’s imperative to get out of your seat every hour and move. “Get in the habit of fidgeting when you’re sitting,” says Ansell. Point your toes downward and upward, make circles, and heck, even try spelling out the alphabet. The key is to keep the blood flowing.

And, although being well-hydrated (a.k.a. asking the kind flight attendant for ice water instead of extra ice for your vodka cranberry) is never a bad idea—there is no definitive evidence to show that dehydration increases DVT risk. Pushing fluids might, however, push you to get up more frequently to use the facilities, and reduce your risk that way.

While you don’t need to be overwhelmingly alarmed about your blood clot risk, you should definitely be aware. The bad news is that we’re talking about 100,000 deaths per year from blood clots, but the good news is that most of them can be prevented.

About the Author

Varci Vartanian is a jack (er, Jill) of all trades. After a successful career in healthcare, she traded her lab coat for her current position as chief temper tantrum tamer/play date consultant for her two-year-old. She also enjoys writing short stories, freelance magazine work, and carbohydrates.

Birth Control Side Effects That Aren’t Normal

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You may know that weight gain and breast tenderness can be normal birth control side effects. Some birth control side effects go away over time. But some birth control side effects don’t disappear and can be signs of a serious or life-threatening health condition.

Don’t freak out—most people on birth control don’t have any problems. But you should learn more about some birth control side effects that aren’t normal and that you shouldn’t ignore.

If you’re questioning anything, always speak to your health care provider. Birth control shouldn’t make you feel sick or uncomfortable. You have many options. Your health care provider can help you find another brand or method that works for you.

Just don’t stop taking your birth control before you start a new form of contraception. Otherwise, you’ll put yourself at risk of pregnancy.

Dry eye issues
It’s normal to have dry eyes that can affect your vision when you take birth control. But contact your health care provider right away if you have dry eyes accompanied by discharge or a change in vision. Chronic pill use has a small risk of being associated with an increased risk of open angle glaucoma. If you have no other symptoms, get relief with over-the-counter saline eye drops.

Blood clots
Blood clots, known as venous thromboembolism or VTE, are a rare but potentially serious side effect of oral contraceptives. The risk increases if you smoke and are over the age of 35. Such blood clots usually develop in the lower legs and are known as deep vein thromboses or DVTs. But they can be fatal if they reach the lungs, in which case they are known as pulmonary emboli. Seek medical assistance if you have one-sided calf pain; lower leg swelling, pain or warmth; or shortness of breath or chest pain. The risk of any VTE varies with the type of progestin used in the pill. Smoking and obesity may also increase this risk.

Migraines
Birth control pills can trigger severe migraines in some women. A study found that a drop in estrogen levels can trigger migraines. Thus, for some women, migraines get worse in the pill-free interval (or “dummy” pill time). Already have migraines? You may notice that your headaches get worse when you’re on the pill. That can happen just before your period or even later in the cycle. If you have migraines with “aura” (neurologic symptoms related to vision, such as blurred vision, temporary loss of vision or seeing flashing lights or zigzag lines), taking oral contraceptives puts you at higher risk of stroke and, in most cases, is a reason not to take birth control pills. Talk with your health care professional about what birth control options may be best for you.

Itchy yeast infections
If you take the pill and have issues like poorly controlled diabetes, a diet high in sugar or alcohol or a weakened immune system, you may get more irritating yeast infections. Try an over-the-counter vaginal antifungal cream or a prescription medication. If the problem is chronic, though, you may want to switch birth control methods.

Depression
Depression can develop because of many factors. If you have a family or personal history of mood disorders, you may be more likely to experience depression while taking the pill. A study found that this may be the case because the pill’s synthetic hormones can affect the balance of certain neurotransmitters, or brain chemicals. If your depression is pill related, you may switch to a nonhormonal birth control or one that provides less hormones.

Painful intercourse
Low-dose birth control pills may be linked to uncomfortable sex and chronic pelvic pain. That may be caused by the dive in estrogen, which can lead to sexual side effects like decreased lubrication, painful intimacy and low libido. Talk with your health care provider about any pelvic pain to make sure you don’t have fibroids or endometriosis. You can also ask about other birth control options.

Heavy bleeding
Many women experience intermittent spotting or bleeding while on the pill (called “breakthrough bleeding”). Usually, the longer you take the pill, the more likely this bleeding is to subside. Bleeding so heavily that you need multiple pads is not considered normal for someone on birth control pills. Heavy bleeding can lead to anemia, a condition where your blood has a lower than normal number of red blood cells. If you experience heavy bleeding, talk with your health care provider, who can test you for anemia. Your provider may suggest iron supplements, as well as further evaluation for why you are bleeding so heavily.

Other signs to contact your health care provider include:

  • Chest pain or discomfort

  • Severe pain in your stomach or belly

  • Yellowing of your skin or eyes

  • Aura (seeing flashing, zigzag lines)

  • Sudden back/jaw pain along with nausea, sweating or difficulty breathing

Find out more about birth control pills.

Ms P, aged 37, was a nurse practitioner working in a college clinic that was run by a hospital. She greatly enjoyed the variety of her work and had been there for 5 years.

One day in early April, one of Ms P’s patients, Miss K, came in asking about contraception. The young woman, an 18-year old freshman, was in a relationship and wanted to be sure that she did not accidentally become pregnant. Contraception was a common request from students, and Ms P frequently provided contraceptive counseling. As she normally did, she explained all the choices to her patient, and the patient decided on the NuvaRing contraceptive device, a ring containing hormones that is inserted by the patient each month. Ms P discussed the benefits and risks of the device, including the risk of blood clots, with Miss K. She also went over the NuvaRing fact sheet with Miss K, but she did not bother to write this in the patient’s record. After making sure that Miss K understood everything, the clinician dispensed the NuvaRing and ensured that the patient could insert it properly. The patient thanked Ms P and left the clinic.

On June 1, Miss K returned to the clinic with complaints of shortness of breath and chest pain. She told Ms P that she was feeling tired and had been active on the weekend and had not consumed any water. Ms P noted that the patient also complained of dry mouth and had a family history of heart disease and a chronic heart murmur. The patient’s vital signs were a temperature of 97.9° F, heart rate of 76 beats per minute, blood pressure of 90/60 mm Hg, and a respiration rate of 16 breaths per minute. Her oxygen saturation was 99%. Ms P diagnosed the student with dehydration and did not consider the NuvaRing a precipitating factor for the patient’s symptoms. She advised Miss K to be sure to drink water when she was active and to avoid alcohol intake because that could cause dehydration.

Later that day, Miss K went to her pediatrician’s office with the same complaints. The pediatrician diagnosed her with exercise-induced asthma and prescribed an inhaler, despite the fact that Miss K was not wheezing and had no previous history of asthma.

The next day, June 2, Miss K presented to the emergency department of another hospital with complaints of chest pain, shortness of breath, and heart palpitations. The hospital noted that Miss K was using the NuvaRing. Her EKG and vital signs were declared to be normal, and she was discharged without undergoing assessment for possible thromboembolism.

On June 3, Miss K returned to her pediatrician’s office continuing to complain of chest pain. The pediatrician noted that the pain was persistent without relation to exertion, and it might be related to costochondral pain. He instructed her to return in 2 to 3 days if she did not improve.

On June 4, a Friday, a doctor from the June 2 emergency department visit called and reported abnormalities he had seen on the EKG taken during that visit and suggested that she be seen by her pediatric cardiologist. An appointment was made for the following week. Two days before the cardiology appointment, Miss K complained of chest pain and collapsed at home. Her mother began CPR and called emergency services. Miss K was shocked 3 times and administered epinephrine and vasopressin—the total cardiac arrest time was noted to be 8 minutes.

From the August 01, 2017 Issue of Clinical Advisor

The Blood Clot and Birth Control Pill Link

Oral contraception, or the pill, is a popular form of birth control and is also used to treat a number of conditions, such as irregular menstruation and hormone imbalances or acne. But, like all drugs, the birth control pill is not without risks. Certain types of hormonal birth control may increase a woman’s risk of developing a condition called deep vein thrombosis (DVT), a dangerous type of blood clot that usually forms in the legs. The most serious possible complication of DVT is the possibility that a clot can travel to a lung, resulting in a pulmonary embolism — a blockage of an artery in the lung — which can cause death.

Blood Clot Risk Factors

While just about anyone has the potential to develop DVT, some people are at higher risk than others. Women have an added risk if they’re pregnant or if they take certain types of birth control or hormone replacement therapy (HRT), particularly if they have any of the following risk factors:

  • Are overweight
  • Are sedentary or bed-ridden
  • Have injured a leg
  • Have recently had surgery
  • Smoke
  • Have a family history of blood clots, among other things

Douglas Schuerer, MD, director of trauma at Barnes-Jewish Hospital and assistant professor of surgery at Washington University in St. Louis, Ill., says these risk factors “make the patient’s blood ‘hypercoagulable,’ or easy to clot.”

Blood Clots and Birth Control Pills

Although some newer birth control pills contain only a synthetic form of the hormone progesterone, called progestin, most birth control pills contain both estrogen and progestin. These hormones affect a woman’s ovulation cycle (release of the egg from the ovary) and the lining of the uterus, when taken to prevent pregnancy. When used as hormone replacement therapy, they balance out a woman’s natural hormone levels.

The estrogen found in hormonal contraception is what is thought to increase the risk of blood clots — not by forming the clots themselves, but by making the blood more likely to clot. Any type of hormone therapy that contains estrogen, including oral contraceptives, HRT, or hormone patches, carries a risk for hypercoagulability.

Without a doubt, the birth control pill is a convenient and effective way to prevent pregnancy or to replace lost hormones, but how are you to know if the pill is safe for you?

While all medications have risks, it’s often possible to reduce risk factors by taking certain steps. Before starting hormone pills, discuss your individual level of risk for DVT with your doctor. You may be at increased risk if you:

  • Are a smoker
  • Are overweight
  • Travel frequently, particularly in cramped situations (like flying)
  • Have a personal or family history of blood clots, heart disease, heart defects, or stroke
  • Have high blood pressure over 160/100 mmHG
  • Suffer from severe migraines

Blood Clot Warning Signs

If you do take birth control pills, the best way to protect yourself from blood clots, other than reducing the risk factors you have control over, is to know the signs and symptoms of DVT. If you experience any of these symptoms, contact your doctor immediately:

  • Red, painful areas on a leg
  • Temperature differences in your legs (a leg with a clot may be warmer to the touch)
  • Swelling in one area or on one leg
  • Pain or tenderness in your leg
  • Shortness of breath
  • Chest pain
  • Numbness or weakness that is unusual for you

By asking questions and discussing your risks with your doctor before starting hormone therapy or birth control pills, together you can decide what’s right for you and feel good about your decision.

Media hype blood clot risk of birth control pills

“Deadly risk of pill used by 1m women: Every GP in Britain told to warn about threat from popular contraceptive,” reports the Mail Online.

Combined hormonal contraceptives (or “the pill”) are in the news after letters were sent to doctors to tell them about the latest evidence on the risk of thromboembolism (blood clots) associated with combined contraceptives.

Unfortunately, most of the UK media overhyped the potential risk in their reporting. The Mail’s panic-maximising implication that 1 million women could be at risk doesn’t reflect the reality that only around 12 women per 10,000 taking combined contraceptives are thought to be at risk of having a blood clot in any given year.

The review reinforces the importance that women using combined contraceptives get clear, up-to-date information on the risks and benefits. Importantly, the review found that the benefits of any combined contraceptives far outweigh the risk of serious side effects, and that women who have been using them without any problems do not need to stop.

As Dr Sarah Branch of the MHRA, said: “Women should continue to take their contraceptive pill. These are very safe, highly effective medicines for preventing unintended pregnancy and the benefits associated with their use far outweigh the risk of blood clots in veins or arteries.

What is the latest information about the risk of blood clots?

No important new information on the safety of combined hormonal contraceptives has become available as a result of the recent review. The risk of blood clots with combined contraceptives has been known for many years.

Combined contraceptives contain synthetic versions of the hormones oestrogen and progesterone. It is the oestrogen hormone that is associated with the risk of blood clots, though the type of synthetic progesterone hormone used in the combined contraceptive can influence the risk to a certain extent.

The review found that:

  • the risk of blood clots with all combined contraceptives is small
  • there is good evidence that the risk of blood clots may vary between products, depending on the type of progestogen (synthetic progesterone hormone) they contain
  • combined contraceptives containing levonorgestrel, norethisterone or norgestimate (types of progestogen) have the lowest risk of blood clots
  • the benefits of any combined contraceptives far outweigh the risk of serious side effects
  • prescribers and women should be aware of the major risk factors for blood clots (such as older age, obesity, prolonged immobilisation, surgery, personal history of blood clots, smoking), and be aware of the key signs and symptoms

Symptoms can vary depending on where in the body a clot develops. A clot that develops inside the leg (deep vein thrombosis) can cause a cramping pain, a heavy ache and swelling of the affecting limb. A clot that develops in the blood vessels connecting the heart to the lungs (pulmonary embolism) can cause chest pain, sudden breathlessness and faintness.

What is the risk of blood clots from contraceptives?

The risk of blood clots in the veins varies between combined contraceptives, depending on the type of progestogen they contain, and ranges from five to 12 cases of blood clots per 10,000 women who use them for a year. This compares with two cases of blood clots in the veins each year per 10,000 women who are not using combined contraceptives.

  • combined contraceptives containing levonorgestrel, norethisterone or norgestimate were associated with between five and seven cases of blood clots per 10,000 women who use them for a year
  • combined contraceptives containing etonogestrel or norelgestromin were associated with between six and 12 cases of blood clots per 10,000 women who use them for a year
  • combined contraceptives containing drospirenone, gestodene or desogestrel were associated with between nine and 12 cases of blood clots per 10,000 women who use them for a year
  • the risk associated with combined contraceptives containing chlormadinone, dienogest or nomegestrol is not yet known

However, there are other factors that can increase your risk of a clot, such as age, body mass index and smoking history, and these may change over time.

In which situations is the risk of a blood clot highest?

  • in the first year of combined contraceptive use
  • if you are overweight
  • if you are older than 35 years
  • if you have a close family member who has had a blood clot at a relatively young age
  • if you have given birth in the previous few weeks

If you smoke and are over 35 years old, you are strongly advised to stop smoking or use a non-hormonal method of contraception.

Your risk of a blood clot is increased if you travel for extended periods (for example during long haul flights) or if you have been off your feet for a long time (for example due to injury or illness).

How accurate is the media reporting?

Generally, the UK media’s reporting of this issue is both poor and puzzling. The fact that hormonal contraceptive use can lead to a very small increase in blood clots has been known for decades. Also, this latest advice was actually released in October 2013 by the MHRA and European Medicines Agency. Although the Department of Health has just sent the letters to doctors to tell them about the latest evidence on the risk of thromboembolism.

Importantly, the review reports that women who have been using a combined contraceptive without any problems do not need to stop using it, and that the benefits of any combined contraceptive far outweigh the risk of serious side effects.

To put the risk in context, you are far more likely to develop a blood clot in pregnancy than by using a combined contraceptive.

However, it should be noted there are various groups of women for whom the combined contraceptive is contraindicated (including those who have had a previous blood clot), and those who should use the contraceptive with caution (including those with risk factors for vascular disease such as diabetes). For these groups of women, doctors often suggest alternative hormonal methods (such as the progesterone only pill), or non-hormonal methods of contraception, such as a condom.

How does the new information affect me?

All combined contraceptives increase the rare, but important, risk of having a blood clot. The overall risk of a blood clot is small but clots can be serious and may in very rare cases even be fatal. As said, if you have characteristics that suggest you may be at increased risk of a blood clot, your doctor is likely to suggest an alternative method of contraception.

If you have concerns, you should discuss them with your contraceptive provider at the next routine appointment, but should keep taking your combined contraceptives until you have done so. Suddenly stopping a combined contraceptive may result in accidental pregnancy.

It is important that you recognise when you might be at greater risk of a blood clot, what signs and symptoms you need to look out for and what action you need to take.

Dr Sarah Branch, Deputy Director of the MHRA’s Vigilance and Risk Management of Medicines Division, said:

“Women should continue to take their contraceptive pill. These are very safe, highly effective medicines for preventing unintended pregnancy and the benefits associated with their use far outweigh the risk of blood clots in veins or arteries.

“No important new evidence has emerged – this review simply confirms what we already know, that the risk of blood clots with all combined hormonal contraceptives is small.

“If women have questions, they should discuss them with their GP or contraceptive provider at their next routine appointment but should keep taking their contraceptive until they have done so.”

Analysis by Bazian
Edited by NHS Website

Links to the headlines

Deadly risk of pill used by 1m women: Every GP in Britain told to warn about threat from popular contraceptive

Mail Online, 2 February 2014

Birth control pills could increase chance of getting blood clots

Metro, 2 February 2014

GPs warn 1m women of deadly blood clot risk

The Times, 2 February 2014

Blood clot warning for 1m contraceptive pill users

The Daily Telegraph, 2 February 2014

Pill poses risk of blood clots, GPs warned

The Guardian, 2 February 2014

Blood clot risked doubled for some new contraceptive pills

Daily Mirror, 2 February 2014

Women warned of contraceptive pill blood clot fears

ITV News, 2 February 2014

Links to the science

MHRA.

Press statement: MHRA responds to European Medicines Agency recommendation following review on combined hormonal contraceptives

October 2013

European Medicines Agency.

Benefits of combined hormonal contraceptives (CHCs) continue to outweigh risks – CHMP endorses PRAC recommendation

November 2013

With Birth Control Pills, New Isn’t Always Better

Birth control pills are often marketed as doing much more than prevent pregnancy. The drugs also claim to treat acne, moodiness and bloating. But some researchers caution that these benefits do not outweigh the health risks known to accompany taking the pill. iStockphoto.com hide caption

toggle caption iStockphoto.com

Birth control pills are often marketed as doing much more than prevent pregnancy. The drugs also claim to treat acne, moodiness and bloating. But some researchers caution that these benefits do not outweigh the health risks known to accompany taking the pill.

iStockphoto.com

Bayer HealthCare, the leading maker of birth control pills, is coming out with a brand new pill.

Natazia, as it’s called, contains a form of estrogen that’s never been used in an oral contraceptive. It also has a novel dosing regimen. Women on Natazia will take four different combinations and doses of hormones or sugar pills each month.

The new launch coincides with growing problems for Bayer’s last new contraceptive, Yaz.

Beyond Birth Control

After Yaz came out in 2006, it quickly became America’s No. 1 birth control pill, bringing Bayer $800 million last year. But now thousands of women are suing Bayer because they say Yaz caused them serious harm. Sales have dropped 15 percent in the past year.

It’s a good time to look at the Yaz saga and see if it has anything to teach women and their doctors when they choose a contraceptive.

Yaz was something entirely new in the long history of birth control pills — and not just in its chemical formulation. It was the first pill to be marketed for multiple purposes. Bayer promoted it heavily as going “beyond birth control.”

A centerpiece TV ad noted that “all birth control pills are 99 percent effective and can give you shorter, lighter periods. But there’s one pill that goes beyond the rest. It’s Yaz.”

On the screen, brightly colored balloons floated upward. Each balloon had a label — moodiness, irritability, feeling anxious, increased appetite, bloating, fatigue, headaches, muscle aches, acne. In the background, The Veronicas sang “Goodbye to You.”

Katie Anderson, shown with her mother, Beth, suffered a life-threatening pulmonary embolism. Her symptoms started within a month of taking the birth control pill Yaz. Jane Greenhalgh/NPR hide caption

toggle caption Jane Greenhalgh/NPR

Katie Anderson, shown with her mother, Beth, suffered a life-threatening pulmonary embolism. Her symptoms started within a month of taking the birth control pill Yaz.

Jane Greenhalgh/NPR

A Cautionary Tale

Those ads caught the attention of a 16-year-old in Maryland named Katie Anderson.

“I do remember going to the gynecologist and asking for Yaz because I had seen the commercials,” says Anderson, who’s now 19. “That was the one I wanted.”

Anderson hoped Yaz would even out her irregular periods. She liked the implication that Yaz could treat premenstrual syndrome. And, of course, the idea of clear skin appealed to her, too.

So she got her doctor to write a prescription for Yaz. It’s a choice she’d live to regret.

Misleading Ads

We’ll come back to Katie Anderson’s story. But first, let’s hear from professor Ruth Day of Duke University. She advises the Food and Drug Administration on “medical cognition” — people’s comprehension and use of medical information in advertising and drug labels.

Day says she’d never seen a campaign that made such sweeping claims as those Yaz ads. She showed the “balloon” ad to dozens of young women and asked what they thought.

“Most people thought it was going to prevent all those symptoms, period,” Days says.

For instance, 97 percent thought Yaz can treat ordinary PMS.

“It does not,” Day says, noting that the FDA approved Yaz for treating a more serious and less common condition called PMDD — premenstrual dysphoric disorder.

Day also asked her research subjects if they thought Yaz treats mild acne. “Sixty-four percent said, ‘Yes, it does.’ But the truth is, it does not treat mild acne,” she says. “So people were getting this idea that Yaz ‘goes beyond.’ But they were getting the wrong message.”

The FDA agreed. Officials declared the ads misleading and ordered Bayer to run a corrective commercial. But Day found the corrective ad still left a lot of misconceptions about what Yaz can and can’t do.

But there’s no question Bayer’s aggressive ad campaign worked. Yaz catapulted past all other birth control pills — and became Bayer’s top-selling drug.

So one lesson from the Yaz saga is: Be wary of claims that a potent pill will solve all your problems — it’s probably not true. And as Day’s research has found out, all those claimed benefits tend to cloud people’s appreciation of the potential risks.

Related Blog Post

New ‘Morning After’ Pill Works Five Days Later, Too June 11, 2010

Consider The Risks

Katie Anderson learned that the hard way. She began having persistent leg pains within a month of starting on Yaz.

“I started developing this kind of pinching, twinging, numbing kind of feeling in my left butt cheek,” she recalls. She thought it was a pinched nerve.

Then a couple of weeks later, she was awakened with terrible chest pain.

“She tells me she woke up about 5 o’clock in the morning,” says Beth Anderson, Katie’s mom. “She sat bolt upright in bed — couldn’t move, couldn’t talk, was trying to cry as silently as possible because it hurt to breathe.”

Her doctor diagnosed pleurisy, an inflammation of the chest lining that isn’t serious, and prescribed Motrin. That helped for a while, but over the next few days, Katie developed shortness of breath. And her left leg went totally numb and cold.

“My left leg was completely purple,” she says.

It turns out an enormous blood clot had formed in her leg. A piece of it had broken off and lodged in her lung. Doctors call that a pulmonary embolism, and it can be deadly.

The link between birth control pills and blood clots isn’t new. It’s been known for decades. Every year a few thousand U.S. women suffer clots because they’re on the pill.

It’s possible that Yaz and Yasmin, a similar pill, carry a higher than usual risk of clotting.

Newest Pills Not Necessarily Safest

Danish researchers decided to compare the experience of millions of women taking different contraceptives. “Denmark is the only country in the world with national registration of all women with thrombotic events , whether in public or private hospitals,” says Ojvind Lidegaard of Copenhagen University. “We also have a detailed record of women’s medication history.”

Lidegaard’s group found that women taking Yaz or Yasmin had a 64 percent higher risk of blood clots than women taking pills that have been around for decades. Their study was published late last year in the British Medical Journal.

A 64 percent higher risk is not dramatic. But it’s worrisome, given the fact that millions of women are taking the pills.

“The safest is still, surprisingly, one of the oldest pills,” says Dr. Frits Rosendaal, an expert in clotting disorders at Leiden University in Holland.

Rosendaal led another study that also found that women taking Yaz have a higher risk of clotting than those on older birth control pills — about twice as high. That paper also appeared in the British Medical Journal.

“There are convincing indications this pill is less safe than other pills,” Rosendaal says, adding that there’s really no difference in Yaz’s effect on other menstrual symptoms.

Bayer strongly disagrees. The company wouldn’t make a spokesman available to talk about these issues. In a statement, it said that studies the company funded show its pills are no riskier than other contraceptives.

For its part, the FDA looked at all the studies. It found flaws in the Danish and Dutch results. The agency has commissioned its own study, due out sometime next year. The leader of that study, Dr. Stephen Sidney of Kaiser Permanente Health Care, says his reading of the data so far is that “it’s a bit of a mix,” and that the relative risk of Yaz and Yasmin “is an open question.”

Some Women At Higher Risk

On one point, there’s no controversy. Some women have a much higher risk of clotting and death when they take birth control pills. And most of them don’t know they’re at risk.

Katie Anderson was one of these. She has a “superclotting” gene called Factor V Leiden. In fact, Rosendaal’s group in Leiden discovered it.

The gene makes her 35 times more likely to develop a blood clot when she takes any oral contraceptive. With Yaz, her odds might have been even higher.

Factor V Leiden isn’t rare. Rosendaal says about 1 in 5 Caucasians has it, but it’s not routinely tested for. It turns out Katie’s father has the gene. Beth Anderson says she pointed that out to Katie’s doctor before she went on birth control pills.

“I wanted to make sure that wasn’t going to be an issue,” Beth Anderson says. The doctor, she reports, “said she was not aware there was any specific problem with that.”

The leaflets inside all packets of birth control pills warn women not to take them if they have a family history of clotting. But that’s often not mentioned in TV ads. The ads for Yaz simply warned that women over 35 shouldn’t smoke because that increases the risk of blood clots.

“Both Katie and I assumed that since she was well under 35, she wasn’t overweight, and she had never smoked, that it would be safe,” Beth says. “We assumed wrong.”

Katie is now one of 2,700 or so women suing Bayer over Yaz. Three years later, she’s left with a massive clot in her leg that requires her to wear a compression stocking to prevent swelling. She can’t do many of the things she loved to do, and can’t be on her feet for long. The clot may never go away.

So another lesson is: Women and girls thinking of taking the pill should pay attention to the fine print. Their parents, too, if they’re in the picture. And especially their doctors.

As Katie Anderson puts it: “I want people to understand it’s not just a little pill. I want people to understand the risks, understand what the symptoms of a blood clot are like, and really to take it seriously.”

New Pill On Market

So now, Bayer’s introducing another birth control pill.

This happens over and over again. It’s the way the pharmaceutical business works, especially when there’s an enormous market like the one for birth control pills. (About 13 million American women take them, and 100 million around the world.) To garner market share, companies regularly come up with new formulations and market them as new and improved.

The pressure’s even greater when lawsuits have dimmed the luster of a previous drug, or when a company faces competition from generic versions, as is now true of Yaz.

Dr. Edio Zampaglione, senior director of medical affairs for women’s health care at Bayer, and the official in charge of the company’s latest new pill, says its launch has nothing to do with these economic factors. He says Bayer developed Natazia because women need more contraceptive options.

“Each woman is different, and each woman will feel differently on these different types of hormones and will react differently to them,” Zampaglione says.

To some, that might be an argument for caution. When a new birth control pill comes out, no one really knows how millions of women will react to it. Pre-market studies of Natazia involved only about 3,000 women. The unknowns are even greater when a contraceptive contains hormones and combinations never used before.

Beth Anderson says Katie’s story contains a final lesson for women tempted to take the new pill.

“Really, the moral of the story is that you shouldn’t use the latest and greatest drugs unless there’s some reason that the ones that have been around don’t work for you,” she says.

That’s the philosophy of Rosendaal, the Dutch clotting expert.

“Personally, I would not start using a new drug unless it’s proven to be better,” Rosendaal says. “Because we know that all drugs have side effects, and we also know that for newer ones which have not yet been used by millions of people, the side effects are generally unknown.”

Bayer is monitoring how its new pill is doing in up to 70,000 women. But results of those studies won’t be available for at least five years.

For Some Women, the Side Effects of Hormonal Birth Control Are Unbearable

Share on PinterestIllustration by Ruth Basagoitia

On a late summer afternoon three years ago, I was on my way home after a relaxing day at the beach with a friend when something frightening happened: I suddenly couldn’t breathe. My heart also began beating rapidly and my right arm went numb.

The episode passed, but I was worried. I was in perfect health as far as I knew. I immediately made an appointment with my family doctor. When she couldn’t determine a cause for the symptoms I described, she asked if anything had recently changed in my life.

I mentioned I had an intrauterine device (IUD) fitted a few months ago, believing it was my best option for long-term birth control. I told her I’d also noticed some lower back and abdominal pain since then. I asked if the IUD could be causing my discomfort and wondered if it might be responsible for my recent heart palpitations too.

My doctor was dismissive. “The IUD is localized in your uterus,” she explained. “So, I highly doubt it would be affecting your heart.”

After determining my back and abdominal pain were my body’s way of welcoming me to life in my 30s, she sent me on my way, assuring me I had nothing to worry about.

Over the next couple of years, I experienced a constellation of symptoms that came and went with varying degrees of severity. These included a deep radiating pain in my left leg that made it difficult to stand for long periods of time, a tingling sensation in my hands and feet, and even occasional vertigo. I also noticed a creeping nervousness that began to accompany me everywhere.

I sought additional opinions. I was convinced all these symptoms were somehow connected to my IUD. Yet, every doctor I saw assured me any link between what I was experiencing and the contraceptive I’d chosen was all in my head.

Frustrated with doctors who dismissed my concerns, I began my own research and soon discovered I wasn’t the only woman experiencing such side effects. Others were sharing their stories, including director Sindha Agha, who began suffering physical problems after being fitted with an IUD.

In her short film “Birth Control Your Own Adventure,” Agha chronicles her experience navigating the healthcare system as she struggles to find relief. On her journey, she discovers that, indeed, the progesterone-only IUD has been known to cause a wide range of side effects, including psychosis in some women.

The film provides an alarming look at the cavalier attitude some in the medical community have adopted regarding the potential debilitating side effects from different types of birth control. It also sheds light on the normalization of women’s pain which often leads to the mistreatment of their symptoms.

(Watch the short film below.)

History of dismissal

The medical establishment has a long history of undermining women’s experiences. In the days of ancient Greece, the uterus was believed to be a living creature that rendered women insane. Centuries later in the early 1900s, doctors viewed women as slaves to their fluctuating hormones, often dismissing many symptoms as hysteria.

While hysteria is no longer an official diagnosis, women are still struggling to shake sexist stereotypes when it comes to their health. Recent studies have shown younger women were less likely than men to seek medical attention when exhibiting symptoms of a heart attack, fearing they’d be seen as hypochondriacs. Additional data showed that less than one in five medical providers failed to recognize the symptoms of heart disease in women, which can differ drastically in men.

Women’s health expert, author, and cardiologist, Dr. Nieca Goldberg explains that sexist stereotypes still exist in the world of medicine. This can lead to the dismissal of women’s pain, which can — in some cases — result in life-threatening consequences.

“I think that advancements in women’s health, like our understanding of how heart disease presents itself in women, are relatively new,” explains Goldberg. “The areas of the medical field that focused on women were primarily related to pregnancy, childbirth, and also preventing pregnancy, which of course includes birth control.”

Goldberg says the medical community is learning there’s a greater range of ways in which female bodies differ from their male counterparts than previously thought.

“Women are more likely to be susceptible to certain conditions, such as fatigue and nonspecific joint pain. It’s easy to say they’re just depressed or didn’t get enough sleep, but they very well might have an underlying medical issue, or autoimmune disease.”

Studies dedicated to exploring gender bias in medicine found that female patients were given less allotted time than male patients presenting the exact same symptoms.

A long battle

The side effects of hormonal birth control didn’t receive widespread attention until the mid-1960s, about a decade after the initial trials were carried out on a population of impoverished women in Puerto Rico.

Activist and writer Barbara Seaman discussed at length both the physical and mental side effects in her book, “The Doctor’s Case Against the Pill.”

Seaman’s work was celebrated for legitimizing what many women had been experiencing for years, but due to lack of transparency from drug companies — in combination with deeply ingrained sexism — their symptoms were often considered psychosomatic. Seaman played a major role in the Congressional hearings that led to drug companies being forced to include warning labels with birth control.

Over the 50 years since hormonal birth control was officially released to the public, numerous studies have linked it to depression. More recent research has started examining the potential connection between its use and the rise in autoimmune diseases, as 80 percent of sufferers are women.

Yet, every study that provides some evidence validating women’s experiences are often accompanied by numerous attempts to undermine them. A cycle that has been going on for decades.

In her book “Sweetening the Pill,” women’s health advocate and writer Holly Grigg-Spall highlights the backlash women face when attempting to voice their health concerns.

“Women who speak out about their issues with birth control are often made to feel as if they are not appreciative of having the privilege of choice to take control of their fertility,” she says.

Grigg-Spall also emphasizes the various incentives that may cause doctors to either be unaware or downplay reported negative side effects.

“In the U.K., for example, there was an incentive to present the IUD as the first best choice for contraception,” explains Grigg-Spall. “When women present side effects, they may not get the help they need, as a doctor doesn’t see anything wrong with a perfectly healthy woman taking a medication that is common and effective.”

Planned Parenthood reported a 900% increase in women getting an IUD in 2016, reflecting the rapid growth of a movement known as IUD evangelism, which has eclipsed the dark history of the Dalkon Shield— the intrauterine device popular in the 1970s that famously injured over 200,000 women.

Share on PinterestIllustration by Ruth Basagoitia

Promising progress

Despite these obstacles, our understanding of the effects birth control may have on a woman’s overall quality of life continues to evolve.

Dr. Angelica Lindén Hirschberg, professor and women’s health expert from the Karolinska Institute in Stockholm, Sweden, was one of the leading team members who conducted a study last year that found oral contraceptives reduce general well-being.

“Our study showed significant changes in some aspects of sexuality, including reduced desire, arousal, and pleasure in comparison with placebo, which indicate a causal effect,” Hirschberg says. “Furthermore, we found a significant reduction in general well-being in comparison with placebo. In particular, reduced positive well-being, self-control, and vitality. We believe that these results are of great importance since the young women were all healthy, and birth control is not treatment for any disease.”

Studies like Hirschberg’s are proof we’re making progress, and we can fuel that progress to greater heights by raising our voices and sharing our stories.

This is something director Sindha Agha knows well. After the release of “Birth Control Your Own Adventure,” she received an overwhelming response from women, many thanking her for sharing her experience.

“The comments just came pouring in,” she says, “and it wasn’t just from women who are young, but also older women saying that my work made them feel heard.”

I am one of the women who is grateful for Agha’s video. It helped me realize I was not alone after my own adventure with birth control came to an end. After years of seemingly-random symptoms, I decided to have my IUD removed. The frequent pain in my leg disappeared almost immediately, and the regular heart palpitations I was experiencing soon stopped as well. However, the side effects left my body in a state of shock, and I am still recovering some eight months later.

Thankfully, I have found a doctor who is listening to me and we’re working to treat the symptoms I’m still experiencing.

Women are redefining what has long been considered normal thanks to the growing number of activists, authors, and artists speaking out about how their pain was continually dismissed by doctors, only to be diagnosed with a serious condition years later.

If we are going to progress, it’s important we face the dark places that have defined women’s freedom, in particular the complicated history of contraception.

“It was heartbreaking to realize that in many ways we still have to be our own detectives, our own advocates, and sometimes even our own doctors,” Agha says, recalling her realization after the release of her film. “So often we are made to feel like the female body is some crazy mystery that we don’t understand, when actually a lot of these hormonal conditions and diseases that we experience are really common. But since they are not adequately addressed or taken seriously, so many women continue to feel isolated, because we are told it’s all in our heads, but it’s not.”

Though experiences like Agha’s and my own reflect a small percentage of women who’ve chosen to use hormonal birth control, they do occur nonetheless. Not all treatments are appropriate for everyone, and women should be made aware of all potential side effects before they decide which option for contraception is right for them.

10 most common birth control pill side effects

Common side effects of oral contraceptives include:

Share on PinterestHormonal contraception is taken to prevent pregnancy and for other medical reasons.

  • intermenstrual spotting
  • nausea
  • breast tenderness
  • headaches and migraine
  • weight gain
  • mood changes
  • missed periods
  • decreased libido
  • vaginal discharge
  • changes to eyesight for those using contact lenses

We will look at each of these side effects in detail below.

1. Intermenstrual spotting

Breakthrough vaginal bleeding is common between expected periods. This usually resolves within 3 months of starting to take the pill.

During spotting, the pill is still effective, as long as it has been taken correctly and no doses are missed. Anyone who experiences 5 or more days of bleeding while on active pills, or heavy bleeding for 3 or more days, should contact a health care professional for advice.

This bleeding may happen because the uterus is adjusting to having a thinner endometrial lining or because the body is adjusting to having different levels of hormones.

2. Nausea

Some people experience mild nausea when first taking the pill, but symptoms usually subside after a while. Taking the pill with food or at bedtime may help. If nausea is severe or persists for longer than 3 months, you should seek medical guidance.

3. Breast tenderness

Birth control pills may cause breast enlargement or tenderness. This normally resolves a few weeks after starting the pill. Anyone who finds a lump in the breast or who has persistent pain or tenderness or severe breast pain should seek medical help.

Tips for relieving breast tenderness include reducing caffeine and salt intake and wearing a supportive bra.

4. Headaches and migraine

Share on PinterestSome people experience side effects with “the pill,” such as irregular periods, nausea, headaches or weight change.

The hormones in birth control pills can increase the chance of headaches and migraine.

Pills with different types and doses of hormone may trigger different symptoms.

Using a low-dose pill may reduce the incidence of headaches.

Symptoms normally improve over time, but if severe headaches start when you begin taking the pill, you should seek medical advice.

5. Weight gain

Clinical studies have not found a consistent link between the use of birth control pills and weight fluctuations. However, fluid retention may occur, especially around the breasts and hips.

According to one review, most studies have found an average weight gain of under 4.4 pounds (2 kilograms) at 6 or 12 months with progestin-only birth control. Studies of other birth control methods showed the same gain.

Some types of hormonal contraceptive have been linked to a decrease in lean body mass.

6. Mood changes

Studies suggest that oral contraceptives may affect the user’s mood and increase the risk of depression or other emotional changes. Anyone experiencing mood changes during pill use should contact their medical provider.

7. Missed periods

Even with proper pill use, a period may sometimes be missed. Factors that can influence this include stress, illness, travel, and hormonal or thyroid abnormalities.

If a period is missed or is very light while using the pill, a pregnancy test is recommended before starting the next pack. It is not unusual for a flow to be very light or missed altogether on occasion. If concerned, seek medical advice.

8. Decreased libido

The hormone or hormones in the contraceptive pill can affect sex drive or libido in some people. If decreased libido persists and is bothersome, this should be discussed with a medical provider.

In some cases, the birth control pill can increase libido, for example, by removing concerns about pregnancy and reducing the painful symptoms of menstrual cramping, premenstrual syndrome, endometriosis, and uterine fibroids.

9. Vaginal discharge

Changes in vaginal discharge may occur when taking the pill. This may be an increase or a decrease in vaginal lubrication or a change in the nature of the discharge. If vaginal dryness results, added lubrication can help make sex more comfortable.

These changes are not usually harmful, but alternations in color or odor could indicate an infection. Anyone who is concerned about such changes should speak with their medical provider.

10. Eye changes

Hormonal changes caused by the birth control pill have been linked to a thickening of the cornea in the eyes. Oral contraceptive use has not been associated with a higher risk of eye disease, but it may mean that contact lenses no longer fit comfortably.

Contact lens wearers should consult their ophthalmologist if they experience any changes in vision or lens tolerance during pill use.

6 Little Known Secrets About Hormonal Birth Control Every Woman Should Know

The birth control pill was approved for use in the United States by the FDA in 1960. Today, 11 million women in their reproductive years are taking birth control pills in the US, while methods like the IUD have gained more usage and popularity in recent years. Because hormonal birth control is so widely used in the US and other countries, women should be aware of the following risks and side effects.

Two categories are hormonal and non-hormonal birth control methods. This article will cover hormonal birth control. Different types of hormonal birth control include:

  • Oral Contraceptives aka “The pill” with combined or uncombined hormones
  • Intrauterine Devices aka IUD, rings, implants, sponges
  • Birth Control Injection like Depo Provera

Stroke

Cardiovascular and cerebrovascular strokes are among the top causes of death in the US. Therefore, minimizing risk is obviously extremely important. According to the American Stroke Association, women who take even a low-estrogen birth control pill may be twice as likely to have a stroke than those who don’t, and the risk may increase if other risk factors are present (1). It’s important to do all that we can in our control to avoid serious conditions like stroke.

Cancer

Many factors influence our risk of cancer. According to the cancer.gov website, research has shown a correlation with birth control use and certain cancers. A large Danish study in 2017 reported breast cancer risks associated with more recent formulations of oral contraceptives (2). “Overall, women who were using or had recently stopped using oral combined-hormone contraceptives had about 20% increased relative risk of breast cancer compared with women who had never used oral contraceptives.” The association between “the pill” and cervical cancer was even greater. Women taking oral contraceptives from 0-5 years had a 10% increased risk of developing cervical cancer. For women who’ve been taking birth control for over 5 years, the risk skyrockets to 60%, and doubles after 10 years of use (3).

Migraine Headaches

Headaches can occur for a number of different reasons. They have been linked stress, cardiovascular health, nutrient deficiencies, and hormonal imbalance (3)(4). Most medical providers can only offer prescription drugs that may partially mitigate the pain of headaches at the expense of side effects. If you suffer from migraines or other types of headaches, it is extremely important to have your hormones and nutrient levels tested by a functional medicine practitioner who will help you look for the root of the problem.

Depression

This 2016 study showed an association between hormonal birth control and increased risk of depression, especially among adolescents (5). The study suggests that those who were on hormonal contraception were more likely to subsequently be taking antidepressants. In fact, the women with a uterine implant had a 2.1 fold risk of needing an antidepressant.

Nutrient Depletion

Long term (and even short term) use of oral contraceptives can lead to depletion of micronutrients that are vital for numerous cellular functioning. One study showed that females on oral contraceptive pills for at least 3 months experienced decreased serum zinc, altered tissue uptake of zinc, as well as decreased bone turnover (6). Zinc is essential for cardiovascular health and immune function. Furthermore, according to the World Health Organization, use of birth control pill has been shown to deplete key nutrients like folic acid, vitamins B2, B6, B12, vitamin C and E and the minerals magnesium, selenium and zinc (7). These nutrient deficiencies can lead to headaches, joint pain, inflammation, and other chronic diseases that have become so commonplace in today’s Western societies.

Post Birth Control Syndrome

Post Birth Control Syndrome (PBCS) is a lesser known consequence of birth control but can be a significant challenge for some women. PBCS is a collection of symptoms women experience after coming off “the pill” that may include (but not always) difficulty getting pregnant, hormonal dysregulation, missed periods, irregular bleeding, acne, cramps, and other hormone-related issues.

Most women, even younger females in their 20’s and 30’s, may not realize that they do not have to live with these symptoms. Oftentimes, having your hormones testing using the most accurate and up-to-date testing, as well as looking for any nutrient deficiencies can clear up most, if not all symptoms of PBCS.

Conclusion

The reality is that most women are currently taking, or have been on some form of birth control, at some point in their lives. Just because it is common for women to take birth control, doesn’t mean that women should assume that it doesn’t have any consequence on their health. There are many risks from stroke to migraine headache, depression to hormonal dysregulation. In future posts, we’ll cover how other hormones and body systems are effected by disrupting the balance of sex hormones.

The good news: Many of the issues caused by birth control use can be addressed easily by lifestyle and behavioral modifications. To achieve optimal wellness, ensure that your birth control isn’t causing hormone problems or nutrient imbalances by talking with your alternative healthcare provider about nutritional strategies and testing.

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