By Aleksandra Piotrow
“They give it like a vitamin,” says 31-year-old Sielke Kelner about doctors prescribing the contraceptive pill. Four years ago, at just 27, she had a thrombosis. A blood clot formed in one of the veins in her brain. The doctors never told her about side effects she could suffer from when giving her the Pill. “They didn’t even mention one side effect, not even talking about the possibility of thrombosis,” she says.
She was fortunate to avoid long-term effects. “The neurological thrombosis can cause paralysis, so I was very lucky not to be impacted for life,” she says. Sielke was treated for six months with anticoagulants and was told she’d have to take them for the rest of her life. But another doctor told her that the thrombosis was caused by the contraceptives, so once she’d stopped taking them no further treatment was necessary.
“They give it like a vitamin.They didn’t even mention one side effect, not even talking about the possibility of thrombosis”
Thrombosis is one of the most serious side effects that the combined oral contraceptive pill (COCP) can cause. A 2009 study published in the British Medical Journal found that all Pills available on the market increase the risk of venous thrombosis fivefold in relative terms. This means that women who take them are five times more likely to have thrombosis compared to women who don’t. It has also been found that many women do not use the safest brands.
Dr Frits Rosendaal, the Chairman of the Council of the International Society on Thrombosis and Haemostasis, who lead the study, says researchers knew the Pill can cause thrombosis soon after it came on the market in the 1960s. But their most recent study found that three types are most dangerous.
“The so-called 3rd generation pill containing progestin called Desogestrel or Getodene , 4th generation pill containing progestin called Drospirenone, and pills containing Cyproterone acetate have the highest risk of thrombosis,” he says.
The overall likelihood of thrombosis – the absolute risk – related to the COCPs is not very high. Dr Rosendaal says it is around one to four women per 10,000. In the UK, out of three and a half million of women taking the pill, around 350-1400 per year will most likely develop thrombosis. But around 10 per cent of those will die.
“The risk is very low, but when thrombosis happens it can be fatal. My idea is that if they are all equally good at preventing a pregnancy why would women want to take one that has a higher risk?” he says.
“I was really worried about what effect it was going on have to my body and how it is going to affect my hormones and both of them said there is no evidence that it does anything”
A lack of awareness
The problem is many women are simply unaware of the serious side effects they may suffer from. Our survey of 90 British women aged between 18 and 55 shows that almost 67 per cent don’t recall the doctor specifically telling them about side effects.
Hafiza Ali, a 21-year old from Bath, says that two nurses, one in Bath and one in a sex health clinic in London, didn’t give her information about side effects when she asked. “I was really worried about what effect it was going on have to my body and how it is going to affect my hormones and both of them said there is no evidence that it does anything,” she says.
Hafiza told the nurse in London that she was concerned because the previous time she took the birth control it made her feel very depressed and lowered her libido. But Hafiza said the nurse was reluctant to have a conversation about it. “I was like, fine, I’m gonna go home and do my own research,” she says.
Dr Jasmine Just, from Cancer Research UK, says that the risk profile related to oral contraceptives varies for individuals and that’s why it is a decision women should discuss in depth with their GPs.
“It is very important that they take a proper medical history, whether they take any other medications, if they are non-smoker or a smoker and, ideally, they should be running through major side effects so that the woman can make an informed decision,” she says.
Other effects of the Pill
Besides possibly fatal thrombosis, the pill has also other serious side effects. The newest research, published in November 2016, from the University of Copenhagen confirmed a link between the Pill and depression. And in 2005, the International Agency for Research on Cancer, part of the UN’s World Health Organization, classified hormonal contraceptives as Group 1 carcinogens for breast, cervical and liver cancers.
“If they are all equally good at preventing a pregnancy why would women want to take one that has a higher risk?”
According to the Breast Cancer Prevention Institute report published in October 2016 by Dr Angela Lanfranchi, in the 30 years since records began, there has been a 40 percent increase in invasive breast cancer – where cancerous cells grow into healthy tissues and spreads into the body – and 400 per cent increase in non-invasive breast cancers – one that stays inside the breast.
Statistics from Cancer Research show that one per cent of female breast cancers and 10 per cent of cervical cancers in the UK are linked to oral contraceptives. And a meta-analysis published in the Mayo Clinic Proceedings in 2006 showed an average 44 per cent increase in breast cancer risk in women who took the Pill before having a child.
There is plenty of statistical evidence of negative side effects of the Pill. At the same time, these contraceptives can also have benefits. Besides their main purpose which is to prevent pregnancy, they can also reduce the risk of womb and ovarian cancer or help acne and painful menstruation. Birth control is also often used to treat hormonal problems or for social reasons, such as sexual or career freedom and family planning.
Our survey shows that many would reconsider taking the Pill had more emphasis been given to side effects such as breast cancer or thrombosis
All the information about risks and benefits is crucial in weighing up both sides and making an informed decision, especially that some women might be at a bigger risk than others. Our survey shows that many would reconsider taking the Pill had more emphasis been given to side effects such as breast cancer or thrombosis. 26 per cent answered maybe, 14 per cent answered probably not and eight per cent answered definitely not.
The survey has also found that all women who said they would continue taking the pill were aged under 24. In contrast, almost all who would definitely not take the pill if given this information were aged over 40, which might reflect different priorities between age groups.
The reasons for the gaps in knowledge
Public awareness can have a substantial effect. A 2002 study by the Women’s Health Initiative found that hormone replacement therapy (HRT) increased a woman’s breast cancer risk by 26 per cent. Hormones used in this treatment are similar to those in the Pill.
The results were widely published in the media and 37 million women stopped taking it. By 2007, there was an 11 per cent reduction in post-menopausal breast cancer in women attributed to stopping HRT.
When scientist developed a male contraceptive pill, it likewise showed side effects similar to those experienced by women with the COCP. But, the injection trial was halted because 20 out of 320 participants experienced side effects they called ‘intolerable’ such as mood swings or lower libido, so the pill didn’t pass the test.
The question is why do women not feel well informed about the side effects of oral contraceptives? Especially those taking it on a regular basis for a long period of time.
Dr Rosendaal says the same about thrombosis: “The threat is so low that most of the doctors who prescribe it don’t see it. You really need to follow thousands of women to see the difference.”
“I would say that women wouldn’t feel that way. That women have the right to know what the risks are, however small”
The COCP is still considered a safe medication. The risk both in thrombosis and breast cancer is low and fatal in little cases. For some women, the benefits outweigh the risk of serious side effects. But it is a risk that some women don’t want to take and don’t feel informed about.
Dr Lanfranchi says that the judgement about the risks is made by researchers who are emotionally detached. “I would say that women wouldn’t feel that way. That women have the right to know what the risks are, however small,” she says.
For Sielke the risks would have outweighed the benefits had she known about them. She says: “I would have never taken it if I knew about the risks.”