6:21 pm - 09/29/2009

Anonymous post: HBC and clot risks

Greetings, fellow Superstars! As you probably know, from time to time the VP Team makes posts on behalf of people who wish to remain anonymous or who do not have LJ accounts. This is one such post. Thanks in advance for your helpful comments. :)

P.S. For more info on anonymous posts, see this link.

For the VP Team


Hi, VP!

My OBGYN put me on Ocella (generic Yaz). While researching BC/HBC (as I have not taken it in a long, long time), I came across several sites warning others not to take Yaz due to it's adverse side-effects. Of course this sparked my interest, being a hypochondriac and all, which lead me to different sites about a lawsuit being filed against the company because this particular brand of BC/HBC is known to cause blood clots, gallbladder issues and a variety of other symptoms/severe complications.

Understood most, if not all brands of BC/HBC, will cause some type of symptom(s) or complications depending (though rare). I'm just really concerned now about how much of an emphasis has been placed on this particular brand and the advisory NOT to take.

I guess I'm just looking for a general consensus on this. Should I ask my OBGYN to switch it, or take a chance and see how it goes (took my first pill yesterday)?

Aside from the fact I do smoke (cigarettes) more than I should (1 pack a day), I am otherwise a healthy 22 year old female. With ANY BC/HBC, what is the risk of blood clots associated with smoking at my age?

Many thanks
moshfloorkiller 29th-Sep-2009 10:32 pm (UTC)
all HBC has those risks. the best thing you can do is quit smoking.
personally, i wouldn't take YAZ at the moment because of all the controversy surrounding it, and my best friend took it last year and experienced severe emotional effects. this isn't true for everybody though. it takes about three months for any side-effects to clear up, if at all.
dlb5367 29th-Sep-2009 11:01 pm (UTC)
I believe all birth control recommends that users do not smoke as it will increase their risk of blood clots. However, your risk can't have a guaranteed number, just as mosh's friend's severe emotional effects are the oppposite of mine; Yaz actually decreases my natural emotional side effects (minus my anxiety, it tends to increase that a little bit from time to time).
paraxeni 29th-Sep-2009 11:28 pm (UTC)
Firstly - Ocella is generic Yasmin, not Yaz. Yaz is still covered by it's patent so it has no generic.

Second- even if you were taking Yaz there's no guarantee you'd have bad side effects. Every single hormonal birth control Pill has deaths, illness and side effects associated with it. All of them. Also if someone takes a Pill and has no problems then they get on with their lives. If they get side effects they rush straight to the internet and post madly about it. This means any website with BC reviews will be disproportionately negative in tone. A Pill either suits you or it doesn't. You just have to take it, if it makes you feel bad keep trying till you find one that suits you. Simple as that.
petite_mewsette 29th-Sep-2009 11:54 pm (UTC)
Being on any form of hormonal birth control automatically puts you at an elevated risk for blood clot, according to ... some fancy website about DVT I read a long time ago. Smoking alongside that is probably putting you at moderate to high risk for blood clot and associated complications. Of course, medication affects everyone differently, so I would say just be sure you're very active, pay attention to your body, and give it a go.

If you are still worried, consider NuvaRing which I believe has less incidence of blood clot and other complications because the dose is smaller and more direct (in the vagina).
queensugar 30th-Sep-2009 01:00 am (UTC)
NuvaRing is actually facing very similar lawsuits about blood clot risk, essentially because it uses a different type of progestin than other methods -- the same reason as Yaz, which is extremely low-dose. That progestin has not been shown to be more risky, but some high-profile individual incidents of serious side-effects tend to instantly lead to lawsuits.
petite_mewsette 30th-Sep-2009 01:39 am (UTC)
We tend to be a pretty litigious society. (I think that's the word I wanted to use, anyway...)
queensugar 30th-Sep-2009 02:00 am (UTC)
Right word. ;) And yes, it certainly does appear that way from the outside.
queensugar 30th-Sep-2009 01:25 am (UTC)
You know, we've had a few discussions about this lately.

Here's my personal take on it: in the United States, there are a lot of lawsuits filed, rightly or wrongly, against a lot of things. Some are valid. Some, however -- if I may be frank -- happen because lawyers see a potential opportunity to land a huge case.

Now, as far as Yasmin and Yaz go, basically the concern is that newer progestins may be more likely to cause clots than others. There are studies that suggest that third-generation progestins, including drosperinone, the progestin used in Yaz and Yasmin, are more likely to cause clots.

You can read about some of the evidence here (page 7). Basically, the third-gen progestins have a relative risk for venous thromboembolism (blood clots) of 1.7 compared to second-generation progestins.

This is still an extremely small risk overall. This table shows the risk per 100,000 users per year for two other third-gen progestins; the risk was about 23 in 100,000. (By comparison, the risk for VTE in pregnancy is about 1 to 2 per 1,000.)

Assuming the same odds hold true for the third-gen in Yaz and Yasmin, in other words, the average user is 99.98% likely (if I'm doing my math right) not to get a blood clot while using Yaz or Yasmin. And most of these incidents are non-fatal; the link above estimates about 1 to 6 deaths per million users per year -- in other words, you're 99.9994% likely not to die from taking Yaz or Yasmin in a year.

Now, smoking does increase your risk factor overall (it also increases risk for VTE or DVT even if you're not on hormonal birth control). But whether it's too much risk depends on you, and your thought process around it.

I freely admit that one of the main reasons that I stopped taking hormonal birth control entirely is because I'm a smoker myself, about a pack a day, and the paranoia itself was too much for me, even though I was well aware that my overall risk was miniscule. Sometimes, if one can't beat ill-founded anxiety, it may be better just to avoid the source of it.

But if you really like hormonal birth control, and/or really like Ocella, then you certainly wouldn't be taking huge risks with your health to stay on it.

You might also want to read this old post from VP on the subject:

caustic_sofa 30th-Sep-2009 02:04 am (UTC)
Thanks for the info and link. *sigh of relief* I actually intend to quit smoking next month (lol - wish me luck).

The reason I was placed on Ocella was because of my issues with other forms of HBC prior. High was too high and made me very depressed. Low was too low which ALSO made me very depressed, and a bonus, vaginal infection after vaginal infection (and without being sexually active)...

This probably sounds ridiculous, but so far so good (day 3). I react, despite being a hypo, to medications/the like rather quickly. Good and bad.

Edit: May seem weird. Forgot I had submitted my anon entry at work, and I'm home now, so.. :p
yearofadventure 30th-Sep-2009 02:16 am (UTC)
http://community.livejournal.com/vaginapagina/17113875.html this post yesterday also touched on very similar issues.
altorogue 30th-Sep-2009 03:42 am (UTC)
Just my $.02- I'm on Ocella and I LOVE IT LOVE IT, it makes me not be a crazy bitch. So I actually have very good results in the emotional spectrum. And I believe that whatever risk I have for blood clots is negligible compared to how much it improves my life in general- and, you know, the actual contraceptive part as well. If your doctor prescribed it to you, and he/she was fully aware of you smoking as an increased risk factor, they probably think it's worth a try. Do keep on it for a bit- I felt better in less than a week- "wow, I feel normal again!" :D
ljquin Clots30th-Sep-2009 05:41 am (UTC)
I had two cloys by age 17 (the second causing a major stroke and severe disability). I had never been on H.B.C. and was in perefect health: no smoking, normal blood pressure and cholesterol, no clotting disorder. My point is that while risks in healthy young women are low some of us do get clots. If you really want to go on HBC be sure to have regular checks, stop smoking and perhaps ask your doctor whether a 75mg daily aspirin might be a good idea. In my time on neurological wards I met several young women whose strokes had been attributed to smoking while on the pill. This was 1997, so not sure whether it could have been Yasmin.
ljquin 30th-Sep-2009 05:48 am (UTC)
With my history of clots I was told all HBC was off limits until my gynaecologist deemed a Mirena I.U.S. necessary for controlling periods from Hell. She consulted with my neurologist and a cardiologist and it was decided that the very low dosage of hormone getting into the blood (much of the hormone is released into the uterus with barely any reaching the bloodstream was an acceptable level of risk. I'm nearing nine years on Mirena (It was changed after five) and I love it. Of course there are loads of non-hormonal contraceptive methods out there if you're really concerned. Discuss these with your doctor but bear in mind that they all have downsides, just like HBC.
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