Since 1960, when the FDA first approved it for contraception, “The Pill” has worn the label of being one of the most effective methods (when used correctly) to prevent pregnancy. As decades passed, the tiny pill was discovered to pack a punch in more areas than just contraception. It also reduces risk of ovarian cysts, ovarian cancer and endometrial cancer. Today’s brands can even include tweaked formulas (or good marketing) to help with symptoms of PMS, acne and facial hair.

Now, the Pill potentially has been found to have another effect, this time not so good – on the heart.

The heart of the matter

Researchers at Ghent University in Belgium studied 1,301 women (ages 35 to 55) who had used the Pill. About 81 percent had used the Pill for at least one year, and the average time of use was 13 years. Approximately 25 percent of the women were still on the Pill.

The women’s baseline risk for cardiovascular disease was low. For the study, researchers scanned the carotid arteries (in the neck) and the femoral arteries (in the leg) of the women to measure plaque levels. The results suggested that women had a 20-30 percent increased prevalence of arterial plaque per decade of oral contraceptive use.

Plaque narrows the arteries and reduces blood flow to the heart muscle. Pieces of the plaque buildup can break off and block the arteries leading to the heart, causing heart attack or stroke. Coronary artery disease (plaque buildup – or atherosclerosis – in the arteries leading to the heart) is the most common type of heart disease and the leading cause of death in the US in both men and women.

Time for a change?

So what does this mean if you or someone you know is one of the millions of women in the US that uses oral contraception? Is this reason enough to give the Pill the heave-ho?

Not necessarily, says Richard Smalling, MD, professor and James D. Woods Distinguished Chair in cardiovascular medicine at The University of Texas Medical School at Houston. “Until we know more about this association, women can continue to take the Pill, but need to talk to their doctors and also be cognizant of their cardiovascular risk,” he says.  He also notes that the study was small and some of the women in the study used pills with higher doses of estrogen than are used today.

Even though he says this study is not cause for alarm, he warns that birth control pills are not void of side effects, as many people believe. “The Pill can predispose certain women to have a tendency to form blood clots more easily than if they weren’t on the Pill.” For instance, he says, women who have congenital, undiagnosed holes in their hearts are at particular risk. “A blood clot can slip across the hole and cause embolus (a detached, obstructive clot) to the brain or to the heart itself, resulting in a stroke or heart attack,” he explains.

For the most part, you have to look at your medical situation and weigh the risks and the benefits. When doing so, be sure you look at the whole picture, says Pamela Berens, MD, associate professor of obstetrics and gynecology at the UT Medical School.

There are numerous alternatives to birth control pills – Nuvaring, the Patch, intrauterine devices (IUDs), the Depo Provera shot, condoms, diaphragms and many others – however, there are risks to just about every form of birth control, she says.

Something else worth considering: “What’s often missing in these discussions about the risks of birth control is that pregnancy itself has risks associated with it,” Berens says.

Have that heart-to-heart

The bottom line, Berens says, is you really have to have a detailed discussion with your doctor about what form of birth control is right for you and your situation.

Smalling agrees and adds, “If you’re on oral contraceptives, you also need to review your current risk for heart disease with a general practitioner or general internal medicine doctor (ob/gyns may be less familiar with atherosclerosis),” Women who smoke, have high cholesterol, high blood pressure, diabetes, are obese, sedentary or have a family history of atherosclerosis (all known risks for atherosclerosis) should especially be aware.

Whether you use the Pill or not, Smalling says, it’s very important to reduce other risk factors of heart disease by:

• not smoking
• becoming physically active
• losing weight if you are overweight
• making behavioral changes
• and possibly using medication to help lower cholesterol and/or blood pressure and manage or prevent diabetes

Although this latest news may seem scary and make some women think they should immediately drop their Pills, both experts agree that until further research is conducted, there’s no need to panic. “This is just another piece of information, and while it definitely warrants attention, it shouldn’t cause women to make rash decisions,” Berens says.

 

 

Last Updated: 1-16-2008

 

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