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What's the Deal with Birth Control and Blood Clots?

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The fact that birth control pills can increase your risk of developing blood clots isn't news. This link between elevated estrogen levels and DVT, or deep vein thrombosis—that's blood clotting in major veins—has been reported since the 90s. So surely your risk has improved since then, right?

Alarmingly, that's not exactly the case. "It hasn't really gotten that much better and that's one of the problems," says Thomas Maldonado, M.D., vascular surgeon and associate professor in the Department of Surgery at NYU Langone Medical Center.

In fact, one study found that new forms of birth control pills (containing progestogen hormones, such as drospirenone, desogestrel, gestodene, and cyproterone) actually up the risk even more than older versions of the Pill. (This was also reported back in 2012.)

While blood clots remain a relatively rare occurrence (and older people tend to have a higher risk), it's an issue that continues to kill young and healthy women every year. (In fact, it's exactly what almost happened to this fit 36-year-old: "My Birth Control Pill Almost Killed Me.")

"Awareness still needs to be raised, because the stakes are high, and something can be done about it," say Maldonado. So, as Blood Clot Awareness month wraps up, let's break down what you really need to know about blood clots if you're on the Pill.

There are clear risk factors. It's crucial that every woman understands her own risk, says Maldonado. A simple blood test can determine whether you have a gene that makes you predisposed to blood clots. (Up to 8 percent of Americans have one of the several inherited factors that can put them at greater risk.) And if you are on the Pill, other factors like immobility (like during long flights or car rides), smoking, obesity, trauma, and surgical procedures are just a few of the many influences that can increase your chances of developing a blood clot, he says. (Next Up: Why Fit Women Get Blood Clots.)

The consequences can be deadly. DVT is a blood clot that usually forms in the veins in the legs, and can cause pain and swelling. If this kind of clot breaks off from the vein wall it can travel—like a pebble in a stream—to the heart where it can interrupt blood flow to your lungs. This is known as a pulmonary embolus and can be fatal, explains Maldonado. As many as 600,000 Americans could be affected by DVT each year, and up to 30 percent of people die within just one month of diagnosis, according to the Centers for Disease Control and Prevention.

Prompt diagnosis is life or death. If you experience leg or chest pain—major signs of pulmonary embolus—prompt diagnosis and treatment are crucial, he says. The good news is a diagnosis can be done very quickly with ultrasounds. According to Maldonado, once a clot is determined, your doc will likely recommend you stop taking your Pill and start taking blood thinners for at least for a few months.

But the risk is relatively low. The likelihood of a blood clot for a woman who's not on birth control pills is three for every 10,000—or 0.03 percent. The risk for women on birth control pills increases three-fold—to about nine for every 10,000 women or about 0.09 percent, says Maldonado. So, while it's true that the risk of developing DVT for women on oral contraceptives is relatively low, the concern is still significant simply because so many women take them, he says.

It's not just the Pill. Maldonado explains that all oral contraceptives are associated with some increased risk of DVT since they interfere with your body's delicate balance that works to keep you from both bleeding and clotting to death. However, certain combined oral contraceptives (containing an estrogen and progestin, a synthetic progesterone) carry a relatively higher risk. By that same logic, birth control patches and rings (like the NuvaRing) that also contain a combo of estrogen and progestin can also increase the risk for blood clots. If you have multiple risk factors for clots as mentioned before, avoiding the Pill and opting for a non-hormonal IUD may be the way to go, suggests Maldonado. (Here, 3 Birth Control Questions You Must Ask Your Doctor.)

There are basic things you can do to reduce your risk. While you don't have control over your genetics or family history, there are other things you can control. Avoiding smoking while on the Pill is obviously a biggie. During long seated trips, you should also be sure to stay hydrated, avoid alcohol and caffeine which cause dehydration, get up and stretch your legs, and wear a pair of compression socks.

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