Why aren’t women taking the new Pill told about the higher risk of blood clots?
The first sign something was wrong was a sudden feeling of pins and needles in her left arm. As Carina Trickey, now 33, recalls: ‘It felt as if I’d slept on my arm and made it go numb.’ Then when the slimming club consultant picked up the phone to call a customer, ‘my words came out as gobbledygook — all in the wrong order’.
She adds: ‘I tried to speak again, but was still talking nonsense so I put the phone down. By this stage although I was still sitting down I was feeling dizzy and light-headed, as if I was going to pass out. Then my left arm slipped off the table — I had no control over moving it. I suddenly felt very scared.’
A colleague drove her to A&e where her blood pressure was found to be sky-high. Carina had suffered a transient ischaemic attack or mini-stroke — where one of the blood vessels supplying the brain becomes blocked temporarily by a blood clot. Fortunately, within an hour her symptoms had gone.
‘I couldn’t believe it was possible to have a mini-stroke at 29 and felt very shocked by it,’ says Carina, who lives in harlow, essex, with her husband Steve, 37, a bar supervisor.
Three days later she went back to the hospital for an MRI scan, which revealed that part of her brain had been permanently damaged. She’d actually had a fullblown stroke.
It had been caused by a blood clot, most likely due to her being on the contraceptive Pill, Microgynon. She’d been taking the combined Pill, with synthetic versions of the female sex hormones progesterone and oestrogen, for ten years.
The fact that she was overweight (at 5ft 5in, she then weighed almost 16 st) and had high blood pressure put her at high risk of blood clots from the Pill. But she insists: ‘I’d never been warned about stroke risk. Also, I’d always been told my blood pressure was fine and only gently nagged about my weight.’
Most women who take the Pill do not have side-effects. however, a small number experience nausea, headaches or breast soreness.
Andmore rarely, the combined Pill can increase the risk of a clot. ‘ The Pill is giving you an extra dose of the hormones you have already,’ explains Shazia Malik, a consultant obstetrician and gynaecologist at the Royal Free London nhS Trust and the Portland hospital, London.
‘These higher levels have an effect on the clotting mechanism, making the blood more likely to clot, especially if a woman has other predisposing factors to make her get a clot such as being a heavy smoker, being obese or less active.’
A clot can cause a heart attack, stroke or a pulmonary embolism (a life-threatening lung blockage). There’s been a spate of reports of young women such as Carina experiencing these more serious sideeffects. Last week, a teenager from Caddington, Bedfordshire, was found to have life-threatening blood clots on her lung two weeks after starting on the combined Pill.
emma Carey, 18, was lucky that she’d choked on a hot drink and had been sent to hospital for checks as the clots were then discovered.
Last month 19-year- old model natalie Lovatt, from Manchester, was rushed to hospital with debilitating migraines days after she’d gone on to the Pill. Tests showed she had a blood clot on her brain.
The death last november of ballet student Maria Santa, 17, of Manchester, was caused by blood clots doctors later said may have been caused by the Pill.
The risk of a blood clot is rare. however it is higher with so-called third generation contraceptive Pills ( so- called because they include newer forms of progesterone; brand names include Yasmin, Marvelon, Femodene, Microgynon and Rigevidon).
The effects appear to be linked to progesterone — or rather its chemical form, progestogen. It may be that different progestogens in the thirdgeneration Pill affect the clotting effects of oestrogen, says dr Malik.
Last year, a study published in the British Medical Journal suggested that third generation Pills raise the chance of a serious blood clot fourfold compared with women who do not take any kind of oral contraceptive. (With older contraceptives, women have a two and half times increased risk of a blood clot.)
The risk from the new Pill is around one in 1,000, according to the european Medicines Agency.
Around one million women in the UK take a third-generation Pill and for fit, healthy women under 40, the blood clot risk is generally small.
however, after a report in 2014 suggested these newer Pills were the cause of death for 14 women in France, the Medicines and healthcare products Regulatory Agency urged GPs here to consider a woman’s risk of blood clots before prescribing them.
Any woman known to have a clotting disorder or hormonally-driven illnesses such as breast cancer, for instance, is advised not to use them.
Women need to be better warned about the risks, says Stephanie Barnes. her warning is based on bitter experience.
Four years ago she went to her GP to change her brand of Pill. ‘I’d suffered from acne in my early 20s and my GP had put me on dianette,’ says Stephanie, now 29, from Brighton.
dianette is a hormonal anti-acne treatment but also sometimes used as a contraceptive.
‘It cleared up my skin, but I never felt “quite right” on it and had lots of mood swings, so I asked for another option.’ he recommended Yasmin as it wasn’t as aggressive.
A couple of weeks after swapping brands, Stephanie, who works in events and marketing, started getting migraines for the first time. ‘I’m never usually ill,’ she says.
‘I knew it could be a side-effect of the Pill because it said so on the leaflet but I just thought it was my body getting used to the new brand. Then the migraines seemed to subside.
‘Then I started getting occasional numbness in my right arm, which I thought could be to do with sitting at a desk a lot of the time.’
But then a week after first noticing these symptoms, Stephanie woke one morning and couldn’t feel her right side. ‘From my shoulder to my right elbow was completely numb, and I had pins and needles in my lower arm. My right leg from knee to ankle was blueish purple and my knee was pretty swollen.’
Shegot an immediate appointment with her GP who found her blood pressure was abnormally high — ‘although he said that could be down to me being worried about the situation, he told me to come off the Pill straight away.’
After three or four days the symptoms subsided. She’s not taken any oral contraceptive since and thinks all women should be told the risks of the newer Pills. ‘no side-effects were mentioned, certainly not that I could be at much greater risk of a clot from one of these newer types of Pills.’
holly Grigg-Spall, author of the book Sweetening The Pill: how We Got hooked On hormonal Birth Control, says she’s interviewed ‘hundreds’ of women about the Pill and none had been told that there are serious sideeffects like blood clots with the newer Pill. She suggests older, second generation Pills may be better.
But dr Malik says these newer Pills were developed because there was a need for them.
‘Some women experience greater adverse symptoms such as mood swings and breast soreness on the older preparations.’
She adds that the newer Pills appear to ‘reduce the risk of a heart attack or stroke’ where these are linked to factors that affect artery health, such as cholesterol levels.
‘Also some women find that newer preparations seem to be better tolerated and work better to control problem skin or hair growth or irregular bleeding.
‘While it’s true these newer Pills double the risk of blood clots, we need to remember that the risks are still extremely low — far, far lower than the risk of blood clots in women who are pregnant, for instance.’
But dr Malik admits ‘perhaps women are not always given proper warnings’.
Carina has been told she must never take the Pill again. She’s now on the clot-inhibiting drug clopidogrel, for the rest of her life.
‘The stroke was a wake-up call for my unhealthy lifestyle, though, and two months later I started attending Slimming World classes. I lost three stone over 18 months.’
now 12 st 10lb, her blood pressure is also healthy. But while she’s not had any long term physical effects, the stroke has affected her short-term memory and multi-tasking skills and she can experience tiredness.
‘Of course, I have to take some responsibility for my weight, but if my GP had laid the stroke risks on the line I would have definitely made more effort to lose weight and probably not taken the Pill at all.’