Recent studies indicate a higher likelihood of blood clot formation in women who use NSAIDs together with hormonal birth control, especially with higher-risk variants and diclofenac. Experts recommend heightened awareness and choosing safer alternatives for pain management and contraception.
Although the overall risk remains minimal, it is important to inform women of these findings.
The combination of non-steroidal anti-inflammatory painkillers and hormonal birth control methods may slightly increase the chance of venous thromboembolism (VTE), as revealed by a detailed Danish study published in The BMJ.
The increased risk is more pronounced in women who use combined oral contraceptives with newer generation progestins. However, the risk is lesser for women using progestin-only pills, implants, and IUDs, in combination with NSAIDs like ibuprofen, diclofenac, and naproxen.
The study emphasizes that the overall likelihood of a severe blood clot is still low for women on high-risk hormonal birth control. Nevertheless, due to the common use of both NSAIDs and hormonal contraceptives, women should be made aware of this potential interaction.
Classification of Hormonal Contraception and NSAID Use
The link between NSAIDs and blood clots is known, but the impact of NSAID use on the risk of venous thromboembolism in healthy women on hormonal contraception was less clear.
The research utilized national health records to follow first-time VTE diagnoses among 2 million Danish women aged 15 to 49, from 1996 to 2017, who had no prior history of blood clots, cancer, hysterectomy, or fertility treatments.
Hormonal contraceptives were categorized into high, medium, and low risk for VTE based on previous research.
High-risk contraceptives included combined estrogen and progestin patches, vaginal rings, and pills with 50 mcg estrogen or newer generation progestins. Medium-risk included other combined oral contraceptives and the medroxyprogesterone injection. Progestin-only pills, implants, and hormonal IUDs were considered low or no risk.
The study accounted for various factors like age, education, pregnancy history, previous surgeries, hypertension, and diabetes.
Among the participants, 529,704 women used NSAIDs while on hormonal contraception. Ibuprofen was the most common (60%), followed by diclofenac (20%), and naproxen (6%).
Over a 10-year average observation period, 8,710 VTE events occurred (2,715 pulmonary embolisms and 5,995 deep vein thromboses), with 228 (2.6%) women dying within 30 days of diagnosis.
Implications and Recommendations
In absolute terms, NSAID use corresponded to four additional VTE events per week per 100,000 women not on hormonal contraception, 11 extra events for those on medium-risk hormonal contraception, and 23 extra for those on high-risk options.
Among NSAIDs, diclofenac showed the strongest association with increased risk compared to ibuprofen and naproxen.
This observational study cannot establish causality, and there were limitations like missing data on smoking and obesity. However, the large-scale study with high-quality data allowed for adjustments for various influential factors. Further analysis reinforced the findings, suggesting their reliability.
The researchers suggest that the study provides new insights into the risks associated with using these two drug classes by otherwise healthy women.
They advise women who need both hormonal contraception and regular NSAID use to be informed accordingly.
The findings raise significant concerns about the concurrent use of NSAIDs, particularly diclofenac, with high-risk hormonal contraception, as noted by Morten Schmidt of Aarhus University Hospital in an accompanying editorial.
He urges healthcare authorities and regulators to consider these findings in their safety assessments of over-the-counter diclofenac. He also recommends women on hormonal contraception and their doctors to look for NSAID alternatives for pain relief.
“If NSAID treatment is necessary, alternatives to diclofenac and lower-risk hormonal contraceptives, such as progestin-only pills, implants, or IUDs, are preferable,” he concludes.
The Danish Heart Foundation funded the study.
Table of Contents
Frequently Asked Questions (FAQs) about NSAIDs and birth control clot risk
Does using NSAIDs with hormonal birth control increase blood clot risk?
Yes, recent research indicates that women using NSAIDs in conjunction with hormonal birth control, particularly high-risk types and diclofenac, have an elevated risk of developing blood clots. The study suggests the need for greater awareness and consideration of safer alternatives for pain relief and contraception.
What types of hormonal contraception are considered high risk for blood clots when used with NSAIDs?
High-risk hormonal contraceptives include combined estrogen and progestin patches, vaginal rings, and pills containing either 50 mcg estrogen or third or fourth-generation progestins. These, when used with NSAIDs, show a higher likelihood of blood clot formation.
How significant is the risk of blood clots when using NSAIDs with hormonal birth control?
While the absolute risk remains low, the study highlights that the use of NSAIDs with hormonal birth control, especially high-risk types, does lead to a slightly increased chance of venous thromboembolism. This risk is more pronounced with certain NSAIDs like diclofenac.
What should women using both NSAIDs and hormonal birth control be aware of?
Women using both NSAIDs and hormonal birth control should be informed about the potential increased risk of blood clots. They should consider discussing with healthcare providers the possibility of using alternative pain relief methods or lower-risk hormonal contraceptives.
More about NSAIDs and birth control clot risk
- Blood Clots and Birth Control Study
- NSAIDs and Hormonal Contraception Research
- Venous Thromboembolism and Painkillers
- Safe Alternatives to High-Risk Contraceptives
- Understanding Blood Clot Risks with NSAIDs and Birth Control
- Danish Study on NSAIDs and Contraceptive Use
- Hormonal Birth Control and Pain Relief Safety
- Research Insights on NSAIDs and Blood Clot Risks
4 comments
So, NSAIDs and some birth controls are a bad mix? that’s news to me. Always thought they were pretty safe, but good to know!
This is important info, thanks for sharing. But what are the alternatives to NSAIDs that are safer? Need more info on this.
interesting study but how big is this risk really? they say it’s low but numbers would be helpful. Not sure if I should be worried or not.
wow, this is kinda scary. didn’t know painkillers could up the risk of blood clots like this, especially with birth control. need to be more careful i guess.