Global Health Asia-Pacific August 2021 August 2021(clone) | Page 48

The Pill

While the pill can raise the risk of blood clots , its risks should be put in context

Generations of women have successfully taken oral contraception and managed the risks
“ You have to compare it in terms of lifestyle instances of blood clots in both males and females . When one is on the pill , it does increase that risk by about three to four times .”

Worries that the AstraZeneca COVID-19 vaccine could slightly elevate the risk of blood clots have ignited fears that it could also impact other medications that themselves increase the chance of clotting in patients who use them .

In April , reports surfaced about rare blood clots occurring in people after they ’ d had the vaccine . In the UK , where the AstraZeneca vaccine was developed , blood clots occurred in people taking the vaccine at a rate of roughly one in every 250,000 . By the end of March , 79 cases of rare blood clots had been reported in those who had received the vaccine there , with cases occurring more frequently in younger women . Before long , comparisons were being drawn between the clot risk associated with the vaccine and that of the contraceptive pill in a bid by public health officials to allay concerns about being vaccinated .
By highlighting the much higher risk of getting blood clots for the millions of women who take the contraceptive pill relative to the tiny number of those developing post-vaccination clots , public health officials had hoped to put the matter into perspective .
Any negative press surrounding the vaccines had the potential to derail progress of the British vaccine roll-out programme , which would have put the public at greater risk of contracting and falling seriously ill with COVID-19 . Therefore , it was important to give context to adverse events that were making the headlines .
According to the United Nations , over 150 million women used the oral contraceptive pill worldwide in 2019 . In the UK , it is taken regularly by over three million women , making it one of the most commonly used drugs , even though blood clots caused by the pill are estimated to affect one in every 1,000 users each year , a number 250 times higher than the AstraZeneca vaccine .
“ You have to compare it in terms of lifestyle instances of blood clots in both males and females . When one is on the pill , it does increase that risk by about three to four times ,” Dr Haris Hamza , a consultant obstetrician and gynaecologist at Alpha IVF & Women ’ s Specialists in Kuala Lumpur , told Global Health Asia-Pacific�
“ Although that does seem like a lot , in terms of overall numbers , you ’ re really only looking at a very low risk setting ,” he said . “ It also varies depending on which kind of pill one is on .”
The pill has also been shown to increase the risk of breast cancer , although again by a very low percentage . For instance , if a patient has a very strong family history of breast cancer , she would probably be more prone to it even if she were not on the pill .
The combined oral contraceptive pill contains artificial versions of the female hormones oestrogen and progesterone , which are produced naturally in the ovaries . It works by preventing ovulation and stopping the sperm from reaching the egg by keeping them apart .
It does this by thickening the mucus at the neck of the womb , making it harder for sperm to penetrate and reach an egg . It also thins the lining of the womb , so there ’ s less chance of a fertilised egg implanting and being able to grow . When taken correctly , the pill is over 99 percent effective at preventing pregnancy . Nowadays , the combined pill is very low in oestrogen , the main clotting component , at less than 35 micrograms per dose , while the level of progesterone can vary , but this hormone has no evidence of causing blood clots .
Taking the pill slightly increases the risk of blood clots
46 AUGUST 2021 GlobalHealthAsiaPacific . com