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Weighing the Risks of Oral Contraceptives

As a hematologist, I specialize in weighing the risks of taking estrogen-containing oral contraceptive medications. There is strong evidence that these medications are associated with clotting, including deep venous thrombosis (DVT), pulmonary emboli (PE), and stroke.

For many years, the main risk assessment before starting to take estrogen-containing oral contraceptive medications included determining whether the woman has hypertension or whether she smokes cigarettes. Both conditions are known to be associated with clotting tendency, so a woman with either condition would be advised not to take birth control pills.

During the past 30 years, we have observed that blood clotting is strongly associated with inherited clotting tendency disorders. Knowing that a woman has one of these disorders would affect her decision about starting estrogen-containing oral contraceptive medications.

Now that we are in the era of understanding your body’s genes, it is easier than ever for women to learn whether they have one of these clotting tendency disorders. Tests for the two most common disorders, Factor V Leiden mutation and Prothrombin mutation, can be done by home saliva samples or blood tests. Sickle cell trait, another common clotting disorder, is also determined by a blood test.

Women who are found to have a clotting tendency, based on either prior blood clots or an identified mutation, may be advised to avoid estrogen-containing oral contraceptive medications, as there may be safer alternative medications to take. A hematologist who specializes in clotting disorders is a valuable resource to provide guidance with medication.

Heme Onc Call, the country’s first telemedicine-based hematology practice, was created to reform the way hematology is practiced. After a careful assessment of your bleeding and clotting history and a review of your test results, you will receive education and guidance, and you will have access to continuous online communication with your hematology expert.

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