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Hormonal Birth Control: Who Is At Risk of Serious Side Effects?

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Almost two months ago, Lucine Health Sciences and Hormones Matter started a new research project called the Real Risk Study: Birth Control and Blood Clots. The purpose of this research is to assess the breadth and depth of blood clot risks and other side effects associated with hormonal contraception. We believe that a deeper understanding of medical and lifestyle influences is crucial to providing women with a complete picture of their personal risk for blood clots while taking these medications.

To date we have collected data on 64 to 87 women (depending on which section of the survey we are analyzing) who have suffered from blood clots while taking hormonal birth control. These blood clots include deep vein thrombosis and pulmonary embolism, as well as strokes. Many women in the study have had long lasting effects even after they recover from the initial effects of the blood clot. And some women, unfortunately, have suffered from fatal blood clots, and a family member participated in the study on their behalf.

Risk Based on How Long Hormonal Contraception Has been Used

It is generally thought that the risk of developing a blood clot is highest within the first year of starting or restarting hormonal birth control. However, in a previous article we reported on some of the early data we had obtained, and we found that most of the women in our study had been on hormonal contraception longer than one year when they developed a blood clot. In our current data set, we have data from 87 women, and the same trend continues. Seventy-five percent of women developed clots after the first year on the medication, and only 25% developed clots within the first year. In some cases, women developed blood clots even after up to 21 to 30 years on hormonal contraception.

Risk for Blood Clots Based on Smoking History

One of the goals of the study is to provide a clearer picture of who is at risk for developing a blood clot related to hormonal contraceptive use. In the information provided by pharmaceutical companies, smoking and being over age 35 are highlighted as being risk factors. For example, the package insert for Beyaz/Yaz, the most popular birth control pill in the U.S., states:

Who should not take Beyaz or YAZ?

Do not use Beyaz or YAZ if you smoke and are over age 35. Smoking increases your risk of serious side effects from the Pill, which can be life-threatening, including blood clots, stroke or heart attack. This risk increases with age and number of cigarettes smoked.

In the previous article reporting on some early results of the study, we analyzed data from a question asking women whether they were smokers when they developed a blood clot. Using data from 87 women, the trend previously reported from our smaller data set was borne out again in a larger data set. Ninety-four percent of women in our study were not smoking at the time of the blood clot, and 78% had never been smokers. So although smoking does increase the risk, not smoking does not mean you are not at risk.

Risk for Blood Clots Based on Genetic or Acquired Blood Clotting Disorders

It is known that having a blood clotting disorder significantly increases the risk of developing a blood clot while on hormonal contraception. These disorders can be genetic, meaning that they are encoded in the genes and the person is born with them, or acquired, meaning that they are a result of an environmental factor occurring during a person’s life, such as a drug exposure or another disease. With genetic blood clotting disorders, there may also be a family history of blood clots in other relatives. Genetic disorders include Factor V Leiden mutation, protein S deficiency, and prothrombin mutation. Acquired disorders include antiphospholipid syndrome, hyperhomocysteinemia (which may also be present as a result of MTHFR mutation), and heparin-induced thrombocytopenia.

We asked if study participants had a family history of blood clots, and if so, which relative had a blood clot. Fifty-eight percent of the women in our study had no family history of blood clots, and therefore, no reason, from a family history perspective, to suspect they would be at increased risk for a blood clot. In participants for whom there was a family history, parents and grandparents were the most common relatives to have had blood clots, at 14% and 12% respectively. Less common was a history of blood clots in an aunt or uncle, sibling or cousin. These results are depicted in the bar graph below. For a parent or grandparent to be the most commonly reported relative with a blood clot is expected, because the risk of blood clots increases with age.

Family History of Blood Clots in Study Participants

Birth control and blood clots - clotting factors 3

Having a family history of blood clots makes it more likely that there is a genetic disorder that increases the risk of blood clotting running in that family.  We asked the women in our study whether they had been tested for blood clotting disorders before starting hormonal contraception. As can be seen below, 89% of the women in our study did not have such testing prior to starting hormonal contraception, and a further 9% did not know if they had any testing. Only 2% of the women were able to state with certainty that they had been tested.

Testing for Genetic Blood Clotting Disorders Prior to Starting Hormonal Contraception

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We also asked if the participants if they had a known clotting disorder, recognizing that some women would have been tested for clotting disorders after their blood clot experience, and thus, even if they did not know about a clotting disorder prior to starting hormonal contraception, they may have learned about it afterwards. Only 20% of the women in our study had a known clotting disorder, as can be seen in the chart below. For the other 80% who answered “not that I know of,” it may be that they were never tested for a clotting disorder, or that they were tested and were negative for all known clotting disorders. So far, we do know from follow up interviews with study participants that in some cases, this testing was done and was negative. Upon completion of the study, we will know how many women were definitively negative for all known clotting disorders. Of the 20% of women who did have a known clotting disorder, none were tested for it before starting hormonal contraception.

Study Participants With Clotting Disorders

Birth control and blood clots - clotting factors family

Of the women that did have known clotting disorders, Factor V Leiden mutation was the most common common disorder, found in approximately 9% of study participants. This is consistent with what is known about Factor V Leiden mutation: it is known to be the most common blood clotting disorder. Other blood clotting disorders were found with low frequency in our study, as can be seen in the bar graph below.

Blood Clotting Disorders Present in Study Participants

Birth control and blood clots - clotting factors

Summing Up

So far, our preliminary data suggest that many of our study participants did not have known factors that would increase their risk of developing a blood clot while on hormonal contraception. The majority of women in our study were not smokers, and did not have a known clotting disorder, and a significant number of women did not even have a family history of blood clots. In addition, most women developed blood clots after the first year of medication use. We will be continuing to assess these and other known risk factors as we continue with our study, as well as trying to identify if there are any previously unrecognized risk factors. However, it seems that any woman using hormonal contraception could potentially be at risk. This makes it especially important to learn the warning signs and symptoms of all types of blood clots, and make an informed choice of whether hormonal contraception is right for you, knowing the risks.

Real Risk Study: Birth Control and Blood Clots

Lucine Health Sciences and Hormones Matter are conducting research to investigate the relationship between hormonal birth control and blood clots. If you or a loved one have suffered from a blood clot while using hormonal birth control, please consider participating. We are also looking for participants who have been using hormonal birth control for at least one year and have NOT had a blood clot, as well as women who have NEVER used hormonal birth control. For more information or to participate, click here.

Stroke After 23 Years on Birth Control Pills

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My name is Detrease Harrison and I am 46 years old.  A month after my 44th birthday I survived a stroke in my sleep. I didn’t smoke or drink. I just happen to be an African-American, and we are TWICE as likely to have a stroke. I was also taking Ortho Novum 7/7/7, a birth control pill that increases the risk of stroke. I had been taking Ortho Novum for 23 years prior to my stroke.

I got out of bed that morning and collapsed. By the grace of God, my mother happened to call. I told her I had fallen, and her quick thinking to dial 911 saved my life. I didn’t understand why I had fallen and I went back to sleep on the floor. Now I realize that it was weakness resulting from the stroke that had caused me to fall. At the time when I got to the hospital, I had facial droop and difficulty speaking. I had a CT scan and my stroke was quickly diagnosed. My doctors said it had been caused by my birth control pills and took me off the pills immediately.

I had a thrombectomy to remove the blood clot, and then was sedated for several days as I recovered. I was hospitalized for 44 days in total. I had the support and love of family and friends who encouraged me to relearn how to walk, dress myself, and sit without falling over. I have been lucky with excellent rehabilitation services in a comprehensive stroke unit at a hospital near me.

I would have to say my biggest motivation to get better was my dog Scooter and the Dallas Cowboys. See, my fan club was going to the Cowboys game in Nashville Tennessee and I wanted to go too. It was the first time I would be leaving the safety and comfort of my mother’s care since my hospital discharge and be on my own, something I had done many times before in my 44 years. With my neurologist’s permission and my friend Kim at my side, I packed a bag and boarded a plane to Nashville.  I tailgated and cheered my Cowboys to victory from my wheelchair. A text message from Jason Witten and a tweet from Dez Bryant were the motivation that I needed to continue doing the things I enjoy doing.

My stroke recovery has not limited me at all. I am back to work as a full-time accountant at Virginia Commonwealth University.  Friends make sure that I still attend all of the happenings in Richmond.

I did not realize that I was at risk of having a stroke because of my birth control pills. Now that I know more about it, I realize that I may have been having transient ischemic attacks (TIA) for about 6 months prior to my stroke. A TIA is just like a stroke, except that the blockage is transient. These episodes serve as a warning sign that a stroke is going to happen, except that I was not aware of this at the time. I had been having episodes of dizziness and headaches leading up to my stroke, and since my stroke I have not had any of these episodes.

In closing, I would like to say that I am here today because of my mother’s quick thinking. I had no idea why I couldn’t get up from the floor that morning and I’m not sure I would’ve called the paramedics. But time equals brain.  So know the stroke symptoms and get help immediately. Don’t wait to feel better. You must be your biggest health advocate, and if something doesn’t feel right go to the doctor.  I used to tell people I had no risk factors for having a blood clot, but almost everyone has some kind of risk factor.

Real Risk Study: Birth Control and Blood Clots

Lucine Health Sciences and Hormones Matter are conducting research to investigate the relationship between hormonal birth control and blood clots. If you or a loved one have suffered from a blood clot while using hormonal birth control, please consider participating. We are also looking for participants who have been using hormonal birth control for at least one year and have NOT had a blood clot, as well as women who have NEVER used hormonal birth control. For more information or to participate, click here.

Sharing My Story, Feeding the Hope

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When I took this job—combing through the Nelson Pill Hearings, researching and writing about the risks with hormonal birth control, working on the Real Risk study—my mother said to me, “Are you sure you want to do that? Are you sure you want to dig up all that stroke stuff?”

“Mom,” I said, a little exasperated. “It’s been 10 years. I’m fine with it.” Duh was close to what I was thinking but didn’t say. The weird thing is, my mom may have been right. Okay, that’s not entirely fair. My mom WAS right. (NEWSFLASH: My mom is right sometimes!) This job has been hard, and not just because reading congressional testimony is draining and because I’m so passionate about this work. It has been hard because it has forced me, nearly every day since November, to examine what happened to me.

I had a stroke because of hormonal birth control and for a long time I believed my doctors (and much of the research I found when writing my thesis) when they said that I was special. That this sort of thing didn’t happen much. Because I thought I was an anomaly, I was able to bury my head comfortably in the sand and call that “dealing with it.”

It hit me that I had not been dealing with it when I sat in a room with Karen Langhart and the parents of four other young women who had died while using hormonal birth control. As they shared their stories, tears slid down my face. I knew I was not an anomaly. It could have easily been my mom sitting in that room and not me.

I’ve written about how important it is to share patient stories. And we’ve written about the importance of the Real Risk Study. I’ve participated in the study. I’ve written my story (all three parts of it: Part 1, Part 2, Part 3). But it has not been easy for me. Which means it has taken unfathomable courage and strength for the families who have lost their daughters. I had to face a sadness that was buried deep under a layer of “getting on with life.” But for these families, the sadness isn’t buried because there is no “getting on with life.” It’s right there, out in the open, raw and exposed. Their lives will never look remotely the same.

When we publish an article about a health crisis or a death related to hormonal birth control it is not because we are alarmists. It is not because we are whiny or dwelling in the past. It is because this work is important. This study is important. I was not an anomaly. The young ladies who were killed by hormonal birth control are not anomalies. They are daughters, wives, sisters. They could be you or someone you love. We share because we are not alone. We are a group of survivors and advocates.

One of the most amazing things that has happened to me from taking this job is that, despite the challenges, it has helped give meaning to what happened to me. I’ve met and connected with amazing people. While much of it has been cloaked in sadness, the thing that shines even brighter in these interactions is hope. And hope is healing. By sharing my story and participating in this research, I am feeding that hope.

It is my wish that you will help feed that hope, too. If you are a survivor of a blood clot or a family member of someone killed by a blood clot and you have been hesitant to participate, now is the time. If you aren’t, I guarantee that you know someone (a friend or relative or a friend of a friend) who has been affected by a blood clot while on hormonal birth control. Now is the time to share this link. Because there is hope in sharing. And healing in hope.

Real Risk Study: Birth Control and Blood Clots

Lucine Health Sciences and Hormones Matter are conducting research to investigate the relationship between hormonal birth control and blood clots. If you or a loved one have suffered from a blood clot while using hormonal birth control, please consider participating. We are also looking for participants who have been using hormonal birth control for at least one year and have NOT had a blood clot, as well as women who have NEVER used hormonal birth control. For more information or to participate, click here.

Risk Communication and Hormonal Contraceptives

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When it comes to the dangers associated with hormonal contraceptives, how is risk communicated to women? Back in the 1960s when the pill first came out, only the doctors and pharmacists received the information pamphlet included with birth control pills. The burden was on them to decide what information to share with women and what information to omit. This was a central theme of the 1970 Nelson Pill Hearings. What are the risks of the birth control pill and how do we inform women of these risks? Here is testimony from several experts about the issue of informed consent.

Dr. Hugh Davis (page 5928): “In many clinics, the pill has been served up as if it were no more hazardous than chewing gum. The colorful brochures, movies, and pamphlets which are used to instruct women about the pill say next to nothing about possible serious complications. The same can be said for the veritable flood of articles in popular magazines and books which have convinced many women that there are few satisfactory alternatives to these steroids and that careful studies have proved there is little or no risk to life or health in the pill… It can be argued that the risk benefit ratio of the oral contraceptive justifies their use under certain circumstances, but it cannot be argued that such a powerful medication should be administered without the fully informed consent of each woman.”

Dr. Roy Hertz (page 6039): “My view would be that the application of these medications in their present state of knowledge constitutes a highly experimental undertaking. That the individual called upon to take these materials, particularly for prolonged period of time, should be regarded as, in effect, a volunteer for an experimental undertaking. I think she should be so informed.”

Dr. John Laragh (page 6167): “I think we have to do everything we can to simplify communication, to use education, to use techniques of repetition, to simplify the package insert. We can only go ahead in this area, and with many other powerful drugs… by full disclosure.”

With so many doctors insisting that women be informed of the risks of using hormonal birth control, we now have concise, unbiased, and easy-to-read risk information that comes with every package. Or do we?

Modern Risk Communication for Hormonal Birth Control

Because of my experience of having a stroke caused by hormonal birth control, I used my master’s thesis to investigate how drug manufacturers communicate the risks of taking birth control pills with respect to blood clots. Specifically, I was interested in determining whether the package inserts fully disclosed the risks for blood clots and whether/how women were informed of these risks by their physicians. The first part of my research assessed the risk communication, provided by the manufacturers, for three different types of hormonal birth control. This included reviewing the warning materials included with each packet of pills and determining whether the following information was included:

  • Did the information state that blood clots are a risk of taking this medication?
  • If so, did the information state that genetic disorders can increase the risk of blood clots?
  • Did the information list symptoms of a blood clot?
  • Did the information tell women with symptoms of a blood clot what to do in that situation (i.e. go to the emergency room, etc.)?

In addition to these questions, each insert was given a general overview of content, design, and language. Language and design play important roles in the understanding of risk and benefit. “Risk information typically is presented in often-ignored smaller print; as part of a large, undifferentiated block of text… or simply hidden in plain view… Even when found and read, risk information often is missing key pieces of information that consumers need to evaluate drug risks” (Davis). Unfortunately for women, this is the case with oral contraceptives.

How are Risks Communicated?

  • All of the inserts were text heavy, used extremely small font, and were designed in such a way that the paper would need to be rotated at least twice to access all of the information.
  • All three inserts had a larger portion and a smaller, perforated portion (presumably for a woman to tear off the larger section and keep the smaller) which means a woman would have to thoroughly read both sections of the inserts fully for all of the risk information (something that is unlikely due to the redundancy of much of the rest of the information).
  • Technically, each of the inserts lists all four points of information that were examined in this study, however, clotting disorders are only mentioned in the smaller sections, while symptoms of blood clots are only listed in the larger sections.
  • Each insert has statistical information about the risks involved with taking the medication but without the disclaimer that it is based on studies run by the very company who makes the medication. (Research has shown that studies funded by pharmaceutical companies that make oral contraceptives produced more favorable results than independent studies of the same medications.)

In general, the most highlighted information on any risk communication for birth control pills is a version of this:

Do not use [pill type] if you smoke and are over age 35. Smoking increases your risk of serious side effects from the Pill, which can be life-threatening, including blood clots, stroke or heart attack. This risk increases with age and number of cigarettes smoked.

I didn’t smoke and I was only 28 when I had my stroke from birth control pills. But the way this is worded leads women to believe that they are only at risk if over 35 and smoke. Which is patently false. All women who use hormonal contraception are at risk for blood clots. In fact, “the reality is that the estrogenic effects of combine hormonal contraceptives increase the risk of a potentially life threatening blood clot (venous thromboembolism or VTE) by between 400% – 700% for ALL women at any age including those that don’t smoke and those that do smoke. (Comparing Annual VTE Impact across 2nd-4th Generation CHC’s in the U.S. 2013).”

As Joe Malone points out in Five Half-truths of Hormonal Contraceptives, these types of warnings (being over 35 and a smoker) infer that if you are neither, hormonal contraceptives are perfectly safe for you. They are not. They weren’t safe for me and they weren’t safe for his daughter.

Another problem with these warnings is the conditional language stating that serious side effects “can be life-threatening.” A stroke, a heart attack, a blood clot—these things ARE life threatening. But as the research shows, conditional language like that helps give the patient confidence in the medication. After all, something like that can’t happen to me…

Would women feel as confident in their choice to use hormonal birth control if the warning accurately read: “This medication increases your risk of life-threatening blood clots by 400-700%”? Doubtful.

The Right To Know

Over 40 years ago, Dr. Edmond Kassouf testified at the Nelson Pill Hearings (pg 6121) about the information the drug companies were providing about birth control pills:

“Some of the pamphlets mislead and misinform, others are frankly dangerous, but all have one thing in common—they all seem to disparage the reader’s right to know.”

I wonder, how much has really changed?

By creating documents that are so text heavy, with dense language couched in conditional terms, in font barely large enough to read, pharmaceutical companies are clearly not designing for their audience, or any audience for that matter. But perhaps that is their intention.

 

Real Risk Study: Birth Control and Blood Clots

Lucine Health Sciences and Hormones Matter are conducting research to investigate the relationship between hormonal birth control and blood clots. If you or a loved one have suffered from a blood clot while using hormonal birth control, please consider participating. We are also looking for participants who have been using hormonal birth control for at least one year and have NOT had a blood clot, as well as women who have NEVER used hormonal birth control. For more information or to participate, click here.

5 Things Not to Say to a Stroke Survivor

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Before I had a stroke at 28 from hormonal birth control (you can read my story here), I didn’t really know what a stroke was. And I certainly didn’t understand the implications or ramifications of what it meant to have an “insult to the brain.”

I knew I had physical and mental limitations, that I needed to learn how to walk again, to put on my socks, to bathe myself. But they also told my family that I may have an entirely different personality. Can you imagine? You wake up one day, have a brain injury, and your personality is completely different? And would you be able to recognize how your own personality had changed or would it be something people would whisper about when they thought you weren’t listening? My sister must have been particularly worried about my personality. I remember one morning she had to butter my biscuit for me after I had tried unsuccessfully several times. “I’ll butter your biscuit for you for the rest of your life,” she said. “I’m just so glad you’re still in there.” At least most of me was. That is to say, I still had my struggles with who I was and who I had been. But really, who doesn’t?

The interesting thing about surviving a stroke is learning what you can and cannot do. To others, even others that are informed about brain injuries, you may look so similar to your pre-stroke self that they take for granted you are the same. But you may not be.

So as a public service announcement for Stroke Awareness Month, here is a list of 5 things not to say to a person who has had a stroke (or any brain injury).

1. “Hold this.”

The disconnect between mind and body when you have a traumatic brain injury is a constant surprise. The first time they handed me the receiver to talk on the telephone, I held it backwards. One time I put a Cheeto in my ear instead of my mouth. When my mother asked me if I wanted to put on some lipstick, I took the tube from her, put it on my lips (or near them), then put the cap back on the raised stick of lipstick, crushing it. In the ICU, when they had me brush my teeth and rinse with a paper cup of water, the nurse instructed me to spit the dirty water back in the cup. I nodded. “Of course,” I thought. Then I promptly swallowed it. One of the most surprising things, and this was long after I’d been discharged from the hospital (and if I’m being completely honest, even now sometimes), is how things get lost in my left hand. I can literally be holding my keys in my left hand and be looking around the house for them.

But it’s not just the things in my left hand. Sometimes I will stand before a trash can with a pen in one hand and a tissue in the other and tell myself, “throw away the tissue, throw away the tissue, throw away the tissue.” Then I always have to bend down and pick the pen out of the trash.

2. “Lift your leg.”

During my rehabilitation, I was a bit of a challenge for my therapists. Most stroke survivors have damage to either the right or the left side of the body. But the damage from my stroke went down both sides of my brain and consequently affected my left arm and my right leg. One of the exercises the physical therapist asked me to do was to raise my left arm while all on all fours. I did. Then he asked me to raise my right leg. I did. “Raise your right leg,” he said again. So I raised it again. “Kerry, raise your right leg,” he said, like I might not have realized he was talking to me. “Right leg. Right leg,” my mom added. “I am raising my right leg,” I said, exasperated. What is wrong with them? I wondered. I looked behind me with complete certainty that I would see my leg raised. Of course I didn’t, but I did catch an expression on my mom’s face. It was the same expression she was wearing when we played Boggle in recreational therapy and I only found a few words. It was the same expression she wore when I smashed her tube of lipstick. It was an expression that seemed to say she wasn’t quite sure who I was.

3. “Write this down.”

A day or two after I got out of ICU, my mom asked me if I thought I could still write. You would think after the sock incident, I might have had my doubts. But I’m clearly a slow learner, because I said, “Sure, I can.” She handed me a notebook and a pen. I recently found that notebook, the picture is above. (My mom would continue to lovingly document these little milestones, just like she had when I was a baby.) When I wrote that, I thought I had done a pretty good job. And considering what my brain had been through, it was amazing I could even hold a pen. But when I look at it now, it breaks my heart a little bit. I’m so lucky that I write flawlessly now. Just kidding! My writing, while mostly legible and mostly on the lines of the paper, is still a mess. Until a few weeks ago, I didn’t even realize that messing up every third word, leaving letters out, adding letters where they don’t belong—that isn’t just how everyone writes. After a highly scientific study of asking a few of my friends, it seems that’s not normal. The first paper I wrote in graduate school, I typed the words male and female as “mail” and “femail.” Every. Single. Time. Even when I would remind myself, it still came out wrong. To this day, I have trouble with homonyms but I usually catch the mistake before I send the email or publish the story. But sometimes I don’t. I hope you’ll bare with me… haha.

4. Glare at them when they park in a handicapped spot.

In fairness, glaring at someone is not saying anything to them, but so much of communication is nonverbal that I had to include it. After my stroke, they gave me a temporary handicapped decal for my car. And while I may have looked relatively normal, I assure you I was not. I couldn’t walk long distances. I found any remotely crowded place to be extremely stressful. I had to sit down halfway through a trip to the grocery store. Day-to-day things that used to be easy were difficult and frustrating. But even more frustrating were the looks that people would give me when we parked in handicapped parking. One woman glared at me in such obvious disgust as we got into our car. She waited to comment until we had closed our doors so I didn’t hear what she said, but I’m pretty sure she heard me when I rolled down my window. As my husband sped quickly out of the parking lot, I hung my head out of the car and yelled, “I had a stroke!” at the top of my lungs. Not one of my finer moments, to be sure. The lesson that remains, and one even I frequently have to remind myself of, is that you really never know what a person is going through just by looking at them.

5. “My (insert friend or relative)’s experience was much worse than yours.”

A few months after I got out of the hospital, I was at dinner with friends when a woman I had just met (a friend of a friend) was surprised to learn that I had recently had a stroke. “My grandfather just had a stroke,” she said excitedly. “But his was way worse than yours. He’s still in the hospital.” Of course, what she meant was that I looked like I was fully recovered while he was still having visible problems. And of course, she probably didn’t mean to be dismissive. But it really bothered me. I had a massive stroke. I didn’t just have blood clots in my brain (an ischemic stroke, which accounts for 87% of all strokes). I also had bleeding in my brain (a hemorrhagic stroke—a much less common and far more deadly stroke). In my mind, I had actually survived two strokes. Yes, I was extremely lucky and I know my recovery was nothing short of miraculous. But that didn’t negate what happened to me nor what I was continuing to deal with. This woman knew nothing of my struggle to get to dinner that night, nor the struggle of the months before (and certainly not of the subsequent years), yet she made a value judgment on what had happened to me based on her grandfather’s experience. As human beings, it’s natural for us to draw comparisons and to find patterns. After all, common experiences and sharing stories are the major ways we connect to one another. And when you are interacting with someone who has had a traumatic brain injury, or any health crisis, it is completely fine to ask questions. But then just try to listen.

If you’ve ever had a health crisis, and many of us have, what have people unwittingly said to you? Or have you ever put your foot in your mouth when dealing with a friend or loved one’s health crisis? I know I have! Leave your answers in the comment section below.

Real Risk Study: Birth Control and Blood Clots

Lucine Health Sciences and Hormones Matter are conducting research to investigate the relationship between hormonal birth control and blood clots. If you or a loved one have suffered from a blood clot while using hormonal birth control, please consider participating. We are also looking for participants who have been using hormonal birth control for at least one year and have NOT had a blood clot, as well as women who have NEVER used hormonal birth control. For more information or to participate, click here.

Being a Feminist: Hormonal Birth Control Not Required

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Before I get further into dissecting the Nelson Pill Hearings I want to pause and talk about feminism and my intent for this project. The history of the birth control pill and the history of feminism are closely tied, because, of course, if women can control when and/or whether they have children, they have power over their own lives. First-wave feminists knew this. It was Margaret Sanger after all who coined the term “birth control” and conceived (pardon the pun) the idea of the pill in the first place. And so it’s no surprise that the release of the birth control pill in 1960 ushered in the second wave of feminism.

Somewhere, somehow, many people confused the right to choose with blind acceptance of hormonal birth control as “freedom.” These may be the same people who liken questioning the government with being unpatriotic. I suggest that in a democracy it is our most patriotic duty to scrutinize whether our government is acting in the best interest of its people. Likewise, as feminists it is our duty to scrutinize what may or may not be serving women.

The F Words – Feminism and Freedom

Many people believe that having unlimited access to every kind of birth control is the only way to be a feminist and therefore speaking out against the pill or other hormonal birth control is anti-women. Let us consider for a moment the types of birth control that are encouraged, advertised, and prescribed, and with these medications, whose body is being affected? Who will pay if these methods fail? Who has to deal with the side effects? As someone who suffered a stroke while on the birth control pill, I am keenly aware of the price that comes with this “freedom.”

Anti-feminists like to write a lot of articles about how women want to have it all—as if everyone doesn’t want to have it all. That’s not a feminist concept, that’s an American ideal. So, yes, as an American I want to have it all. I want birth control that doesn’t come with the risk of blood clots. I want birth control that isn’t going to kill me, make me fat, give me acne, create mood swings, or lower my libido. Why would I want all the freedom to have sex without getting pregnant with none of the desire to actually have sex?

Why is Birth Control the Sole Responsibility of Women?

Which brings us to the question—where is the pill for men? Still being tested? We hear about this birth control for men every few years, but it has yet to materialize. Is that because it’s being more thoroughly tested than any hormonal birth control they have ever released for women? The original birth control pill was tested on poor women in Puerto Rico who were not even informed that they were part of a study. This article cannot even begin to explore how the fertility of poor and minority women has been systematically targeted and abused in the name of limiting population growth. That’s a whole other topic. And I’ll be explaining the Puerto Rican trials more in future articles but it is important to note that there were only two years between when the research in Puerto Rico began and the birth control pill was approved for use in the United States. Yet every article about birth control for men suggests that many more years of study are required before we’ll every see this as a reality.

But maybe there is no pill for men yet because the side effects have been deemed unacceptable?

At the Nelson Pill Hearings, Dr. Whitelaw, a private physician and early fertility specialist, asked, “How many adult males would be willing to take an oral contraceptive faithfully if they were told that instead of a possible 50-plus adverse side reaction only one remained, that being the possible loss of sex drive and libido?” How many indeed.

But if loss of libido doesn’t scare you, how about the “50-plus adverse side reactions”? Even in 1970, hormonal birth control was linked not just to blood clots (and by extension DVT, PE, and stroke) but also to cancer, infertility, miscarriages, and even diabetes and rheumatoid arthritis. And that’s just the beginning.

However, and this is a big HOWEVER- it is not my goal to demonize the pill or any other hormonal birth control. It is not my goal to unnecessarily scare people. It’s simply my goal to educate about the dangers of these hormones that are over-prescribed and under-researched. Because I’m a feminist, I believe it is a woman’s right to choose. But that choice must be an informed one. Soon I’ll be writing more about how women are informed by looking at risk communication with these and other medicines.

Information or Patronization?

From what I’ve read so far in the hearings, every doctor who has testified has agreed that women need to be better informed of the dangers of hormonal birth control. Except one. Dr. Robert W. Kistner from the Department of Obstetrics and Gynecology Harvard Medical School said, “I don’t believe it is good medical practice with any medication to go through the list of possible complications.” And by way of explanation for this he says that if you tell a woman that headaches are a possible side effect of the birth control pill, then they will get headaches. I wonder if the same can be said for blood clots? It is also interesting to note when Dr. Kistner was asked by the committee if he had ever worked for the pharmaceutical companies, he answered, “Yes, all of them.”

Maybe it’s time for people like Dr. Kistner and Senator Bob Dole, who was also at the Nelson Pill Hearings, to stop being concerned with women’s “emotional reactions” to information about the pill. And give us the full story even though he thinks it may “confuse the women we seek to protect.” Because unlike Bob Dole, I think that women not only can handle the truth about hormonal birth control, but that they deserve it. It’s time to stop allowing corporations and agenda-driven legislation to decide what we can and cannot understand, what we do and don’t need to know about medications that affect us.

Because are women really liberated if we have taken the freedom to choose and handed it to pharmaceutical companies?

Real Risk Study: Birth Control and Blood Clots

Lucine Health Sciences and Hormones Matter are conducting research to investigate the relationship between hormonal birth control and blood clots. If you or a loved one have suffered from a blood clot while using hormonal birth control, please consider participating. We are also looking for participants who have been using hormonal birth control for at least one year and have NOT had a blood clot, as well as women who have NEVER used hormonal birth control. For more information or to participate, click here.

A Stroke from Hormonal Birth Control: Part 2

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When I was 28 years old, I had a massive stroke (a cerebral venous thrombosis in the sagittal sinus area) from a combination of birth control pills and a fairly common clotting disorder, Factor V Leiden. You can read the first part of my story here.

Recovering from a Stroke

The repercussions of what having a stroke meant began to sink in after I was moved out of the intensive care unit.

Once in a regular hospital room, a therapist came by to do some tests. She pulled my blankets aside and asked me if I could take off my sock. This test seemed ridiculously easy, but I was willing, just happy that my head no longer hurt. I leaned forward and confidently pulled the sock off my foot. “Great,” she said. “Now put it back on.” So I put the sock back on my foot. Only I didn’t. Because I couldn’t. I stared at the sock in my hand and then I stared at my foot, knowing that I should be able to complete such a simple task, yet unable to.

This was the first of thousands of tests during my recovery. And it was the first of a thousand times when I knew I used to be able to do something that I could no longer do. It is one of the strangest sensations I have ever experienced.

I spent a week in the hospital and another week in an in-patient rehabilitation facility. Before I was discharged to go home (for another month of out-patient rehab), the psychologist told me that things would feel like “Christmas at the mall” instead of say, an ordinary Tuesday afternoon. It was an appropriate analogy for how overwhelming everyday life would be and one that I would come to understand the first time I broke into sobs when I dropped a bowl of cereal on the floor. I was cautioned against trying things like swimming alone, as I might not remember how and accidentally drown myself. They also told me that I had lost millions, maybe billions, of brain cells that I would never get back. And that I might never be able to work a “real” job again.

At home, I set about re-learning things like how to hook my bra, tie my shoes, and wash my own hair. Once I mastered these, I began to wonder what else I could do. I was extremely lucky that I made progress every day, but some days it felt like I’d never be back to normal. I wasn’t sure what normal even was anymore. After the warning from the psychologist, I was scared that I wouldn’t be able to handle a full-time job. And because of the seizures, I could not drive for six months which was devastating and isolating, especially for someone as independent as I had always been. Since I was stuck at home, it seemed like a good time to force myself to relearn math (yet another thing I knew I had been good at but could no longer do). I began to study for the GRE and less than six months later, I was accepted to graduate school.

Searching for Answers

When it came time to write my thesis, I decided to use my stroke as an inspiration for my research. I wanted to know why I had had a stroke, why no one had ever told me the risks involved with taking hormonal birth control, why I never knew there was a possibility that I had a clotting disorder which would greatly increase my risk. In short, I was looking for a smoking gun; someone or something I could point my finger at and say, “Aha! That is where the breakdown occurred. This is who should be blamed!”

But what I found was much more complicated. What my doctors had told me, that I was an anomaly, seemed to be supported by the research that I found. Studies show that most people get a blood clot within a year of starting hormonal birth control. Mine happened 10 years later. I learned that Factor V Leiden is fairly common but that women aren’t tested for it before being prescribed hormones because testing that many women would be expensive. I also found research that said pregnancy is more dangerous than birth control.

Putting aside the false dichotomy that the only two choices a woman has are to be pregnant or be on hormonal birth control, the message I took away from all of my research was that my stroke was an acceptable risk to save countless women from pregnancy. That even though my stroke could have been prevented by a simple blood test before I was even prescribed birth control pills, my value as a human woman was not worth the greater expense. As a child of the 80s and a product of American capitalism, this didn’t shock me as much as it probably should have. After all, I lived in a world of the Ford Pinto. What I didn’t realize at the time and would only come to understand years later, was that I began to internalize the blame for what happened to me. Maybe it was my fault for not knowing the dangers, for not understanding the risks, for being so stressed out that my body failed me.

Was It My Fault?

In researching my thesis, I discovered that pharmaceutical companies intentionally make the risk communication in advertising, and especially in the package with the birth control, dense and confusing. And I also found that women who have taken hormonal birth control don’t adequately understand the potential side effects, nor do they even know the symptoms of blood clots. There is very little accurate information about clotting disorders online. Even if my situation was rare, these facts are extremely troubling. But what I have since come to learn is that my stroke was actually not so rare.

Recently I’ve been contacted by an amazing group of people; researchers, families who have lost their daughters to hormonal birth control, fellow survivors, writers, and scientists. They’ve helped make it clear to me that I’m not just an anomaly. As you can see from the other stories on this site, hormonal birth control has very real, very harmful risks. And we have lost far too many amazing young women to stand idle any longer. Our standard must be higher than accepting these women’s lives as collateral damage. Together with this group of health advocates, we are embarking on a journey to give women what they need-information to make the right choice for them. Because what happened to me was not my fault. It’s time to stop blaming myself. Yet even as I write these words, I still have some doubt. And that doubt shows me that I haven’t fully recovered from my stroke yet. I still have work to do on this journey. And that work may take me the rest of my life. For more on what long-term recovery from a traumatic brain injury looks like, see Part 3 of the series.

Real Risk Study: Birth Control and Blood Clots

Lucine Health Sciences and Hormones Matter are conducting research to investigate the relationship between hormonal birth control and blood clots. If you or a loved one have suffered from a blood clot while using hormonal birth control, please consider participating. We are also looking for participants who have been using hormonal birth control for at least one year and have NOT had a blood clot, as well as women who have NEVER used hormonal birth control. For more information or to participate, click here.

A Stroke from Hormonal Birth Control: Part 1

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I opened my eyes and saw my husband, Josh, holding my hand, looking very serious. He was telling me that we would get through this, that even if I had to learn to walk again, that whatever it took, we would be okay. I remember thinking, “It’s okay, honey. I just have a headache.” We had been married for a year. The next time I opened my eyes Josh was leaning over me. I was on my side in the emergency room and the doctor had just asked him to hold me steady while he gave me a spinal tap to check for meningitis. Josh held me so firmly, terrified by the risks of a misplaced needle, that his arms were shaking from the strain. I tried to tell him, “Don’t worry about holding me. I can’t move anyway.” I had lost the use of my limbs hours before, maybe even days. And now it seemed my power of speech was gone, as well.

The headache had started a month earlier. I remember exactly when because it woke me in the middle of night and I had never had that happen before. We were visiting friends in New York right before Christmas. I got up and took some ibuprofen and didn’t give it much more thought. But it never really went away. I saw a chiropractor. I took more ibuprofen. I checked out a book on meditation. By the time I saw a gynecologist, I also had an unexplainable pain in my left thigh. The gynecologist told me the pain in my leg was probably just a muscle strain and she prescribed Imitrex for the headache, a migraine medication that shrinks the blood vessels in the brain.

The migraine medication made the headache go from dull and persistent to unbearable. I visited a health clinic where the doctor suggested an appointment with a neurologist the following week. That night my left arm started to go numb. I called a local pharmacist who said it might be my birth control pills. That’s crazy, I thought. I’ve been on them for 10 years. I slept on the couch because I couldn’t bear the thought of having to move to the bedroom. The music that had been on the television roared in my head like it had been trapped there on repeat. The next day I called the health center again and they told me to go to the emergency room.

Over the course of the next two days I would take 3 ambulance rides, be sent home from the emergency room twice, begin to lose all control of my body, and be given a very stern lecture by a nurse who thought I needed to learn how to “manage my stress.”

The spinal tap in the emergency room was not the first time Josh had to hold me down. Earlier that day, he tried to restrain me while my body thrashed wildly. During the seizure, I told myself that if I just calmed down, it would stop. It must all be in my head since the doctors said it was just a “tension headache.” We locked eyes, both of us terrified of what was happening to me. When the shaking finally subsided, he asked me if he should call 911. Again. All I could do was nod.

I did not have meningitis. There were blood clots in my brain and because they had not been treated right away, one of the veins in my head had burst and was bleeding. I was having a massive stroke.

Later, Josh would tell me about overhearing the neurologist and the neurosurgeon arguing. The neurologist thought they should operate. The neurosurgeon thought it was too risky. Neither wanted to be there. It was Martin Luther King, Jr. day. (I have since learned never to get sick on a holiday weekend.) In the end, they didn’t operate. I don’t remember exactly when they told me that I had had a stroke. But I know I had no understanding of what that meant. (I find that even now, ten years later, I am still learning.) As far as I knew, that was something that happened to old people. I was 28 years old.

At some point, they told me that I had a clotting disorder and that this genetic anomaly coupled with the hormones in my birth control had caused my stroke. This wouldn’t mean much to me until after I learned how to walk again, do math again, shave my own armpits again.

Not long after I was discharged from the hospital, I had an allergic reaction to the anti-seizure medication. I returned to the emergency room at the request of my neurologist. This time they immediately took me to an examination room. When the doctor walked in, the same doctor who had finally diagnosed my stroke, he said, “I’m so glad to see you. I didn’t think you were going to make it.”

That statement stayed with me throughout my recovery. Because though intellectually I understood that the stroke could have killed me, I never really understood the gravity of the situation until he said that to me. And it made me begin to really consider what happened to me and why.

I was first prescribed birth control pills at the university health clinic my freshman year of college. I wasn’t even sexually active at the time, it just seemed like a rite of passage. Why did no one tell me about the dangers of the pill? I wondered. And why didn’t anyone tell me that I could have a clotting disorder without knowing it? How many other women have this clotting disorder? How many other women have had blood clots? How many have actually died from hormonal birth control? Throughout my recovery, I struggled with these questions. Eventually, I even tried to answer some of these questions with my master’s thesis. For more on my recovery and thesis work, see Part 2 of A Stroke from Hormonal Birth Control.

Real Risk Study: Birth Control and Blood Clots

Lucine Health Sciences and Hormones Matter are conducting research to investigate the relationship between hormonal birth control and blood clots. If you or a loved one have suffered from a blood clot while using hormonal birth control, please consider participating. We are also looking for participants who have been using hormonal birth control for at least one year and have NOT had a blood clot, as well as women who have NEVER used hormonal birth control. For more information or to participate, click here.