Can blood clots attract the attention of young women?

By Søren Beck Jensen, Postdoc TREC

When a woman in Norway seeks advice on birth control from her doctor, 3rd and 4th generation birth control pills may be the recommendation conveyed to her from the Norwegian Medicines Agency.prevansjon

She will also be advised that use of the pills will increase her risk of blood clots from 2/10000 to 5-12/10000 per year depending on her choice1. How she will perceive this information is of course highly individual and with a risk of her ignoring the information.

In late 2012, a young French woman and former user of 3rd generation birth control pills filed a lawsuit against both a pharmaceutical company and the French National Agency for Medicines and Health Products Safety after having suffered an adverse consequence of her pill use. This ignited a heated debate in French media leading to a radical change in the contraceptive methods used by French women turning away from birth control pills associated with the highest risk of blood clots.

One severe, and possibly fatal, consequence of blood clots is pulmonary embolism (PE). Following the lawsuit, a French study investigated the effect of the sharp change in use of contraceptives on the number of PEs in French women in the childbearing age (15-49 years). The study reported a decrease of 322 PE-related hospitalizations between 2012 and 2013, and a decrease of 227 when 2013 was compared to the average of 2010-2012, corresponding to 10.6% and 7.6% decrease, respectively.

The study compared this change to the pattern of PE-related hospitalizations in two non-pill user populations: men aged 15-49 years and post-menopausal women (50-69 years of age). PE-related hospitalization increased by 4-9% for men, whereas postmenopausal women showed a slight decrease or no change in PE-related hospitalization in the same periods. This further supports that the change observed in young women could be attributed to the change in use of contraception.

Lastly, the authors used epidemiological information to estimate the change in PE-hospitalization you would expect after a change in contraceptive use of the magnitude seen in France in late 2012. The estimates fit the observed figures, and the authors concluded that it is likely that the change in the use of contraception has been a major contributor to the decline in PE-related hospitalizations.

To finally answer the question posed in the title, the answer is “Oui”, but is it also “Ja” in Norway? This decision is yours to make.

Reference: Tricotel, A., C. Collin, and M. Zureik, Impact of the sharp changes in the use of contraception in 2013 on the risk of pulmonary embolism in France. Journal of Thrombosis and Haemostasis, 2015. 13(9): p. 1576-1580.


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