Safest Birth Control, Medicine Dangers

MYFOXNY.COM - Medical headlines for Friday, August 14.

OVER THE COUNTER MEDS: A study by the Centers for Disease Control found that  twice as many children were poisoned by prescrption and over the counter medications. The study suggest there be improvements on packaging and parents be more careful when storing medications.

BIRTH CONTROL: Which birth control is the safest when it comes to the risk of blood clots? European researchers say the ones with low estrogen and levonorgestrel.

The researchers found ... 

Levonorgestrel boosted the risk of blood clots by nearly 4 times compared to nonusers.
Gestodene boosted risk by 5.6 times.
Drospirenone boosted risk 6.3 times.
Cyproterone boosted risk 6.8 times.
Desogestrel boosted risk 7.3 times.

The risk of blood clots was also associated with the level of estrogenin the pills, with higher estrogen dose linked with higher risk.
 

CLICK WEBMD.COM FOR THE FULL STORY OR READ BELOW:

By Kathleen DohenyWebMD Health News Reviewed by Louise Chang, MDAug. 13, 2009 -- When it comes to the risk of blood clots, some oralcontraceptive pills are safer than others, according to new studies byEuropean researchers.

"Oral contraceptives with levonorgestrel and a low dose of estrogenare associated with the lowest risk of venous thrombosis [blood clots]and are therefore the safest option," says Astrid van Hylckama Vlieg,PhD, a research fellow at Leiden University Medical Center in theNetherlands, and the lead author of one study.

''Our study shows that there is indeed a difference in the risk ofvenous thrombosis associated with different types of progestins anddifferent doses of estrogens available in the contraceptive," shetells WebMD in an email interview.

Similar results were obtained in the second study, evaluating Danishwomen. Both studies are published in the online edition of BMJ.

Even with differences in risk, however, a U.S. expert who reviewed thestudies for WebMD points out that the differences are small and theoverall risk of getting a blood clot from the pill is very low tobegin with.

The risk of blood clots associated with birth control pill use hasbeen known for decades, with several studies finding a twofold tosixfold increased risk with the use of oral contraceptives. The newresearch confirms earlier findings and adds new specifics about whichhormones carry the most risk.

Birth Control Pills and Blood ClotsVan Hylckama Vlieg and colleagues compared 1,524 women, ages 18 to 50,diagnosed with a first deep venous thrombosis (DVT) of the leg, whichis a blood clot in the leg, or a pulmonary embolism, a blood clot inthe lung, and compared them with 1,760 healthy people.

Women taking oral contraceptives had a fivefold increased risk ofblood clots compared with nonusers, and the risk differed by the typeof progestin. "The newer types of oral contraceptives containingdrospirenone or cyproterone acetate are associated with an increasedrisk compared with oral contraceptives containing levonorgestrel," VanHylckama Vlieg says. Specifically, the researchers found that:

Levonorgestrel boosted the risk of blood clots by nearly 4 times compared to nonusers.
Gestodene boosted risk by 5.6 times.
Drospirenone boosted risk 6.3 times.
Cyproterone boosted risk 6.8 times.
Desogestrel boosted risk 7.3 times.
The risk of blood clots was also associated with the level of estrogenin the pills, with higher estrogen dose linked with higher risk.

In the national Danish study, researchers evaluated the risk of bloodclots among healthy Danish women, ages 15 to 49, who were usingvarious types of birth control pills from 1995 to 2005.

During that period, they observed 4,213 blood clots.

The risk decreased with duration of use and decreasing dose ofestrogen. Like the Dutch researchers, the Danish team found that pillswith levonorgestrel had a lower risk of blood clots than pills thatcontain other types of progestins. They found pills withnorethisterone to be lower risk, too.

Second OpinionThe new research confirms previous findings and adds new information,says Ricardo Azziz, MD, chairman of obstetrics and gynecology atCedars-Sinai Medical Center in Los Angeles, who reviewed the data forWebMD.

"We know that the combination pills [with estrogen and a progestin] doincrease the risk of thrombosis," he says. It's also known, he says,that women with an inherited clotting disorder are at higher risk forhaving a clot if they take the pill.

But, he adds, overall ''the chances of any woman taking birth controlpills having a deep vein thrombosis is low. Of 10,000 women using thepill, in one year's time six will have a deep vein thrombosis."

What's also known, he says, is "the longer you use it the less chanceof having a DVT." That might be due to what experts call "selectionbias" -- women who had a problem discontinued using the pill and thosewho remain on it are simply less prone to blood clotting problems.

What is also important to understand, Azziz says, is that even if therisk of blood clots from one type of pill is twice or more that ofanother, "We are talking about twice the risk for something that isquite rare to begin with."

Women shouldn't go off the pill based solely on the new findings, hesays. What is crucial, he says, is for a woman's doctor to prescribethe birth control pill that's best for her, the one that will belinked with the least side effects. "Some patients will do better onsome pills than others," he says.

Starting with the lower-dose estrogen pills and the ones withprogestins found linked with the least risk is wise, he says. To startwith, he suggests pills with levonorgesterol or norethisterone and alow dose of estrogen.

The risks associated with not taking the pill, including unwantedpregnancy and pregnancy complications, may be higher than the riskassociated with its use, Azziz says.