The contraceptive patch and blood clots?

Dear Alice,

I am currently using the Ortho Evra patch and have not had any problems so far. However, my friend told me that a lot of women have recently been getting blood clots caused by the patch, and it has resulted in their deaths. Is this true? Is the patch safe to use? If not, what is the safest birth control method to use?

Dear Reader,

As a contraceptive user, it's good that you're wanting to keep on top of the latest birth control information available. While Ortho Evra isn't available anymore, its replacements have the same dosages of hormones and have comparable side effects. To address your question upfront, some studies have shown increased risk of blood clots in those that use the patch compared to those that use other types of birth control methods. The concern that's been raised with various versions of birth control patches has to do with the higher amount of estrogen a user is exposed to when wearing the patch compared to other birth control options. Estrogen is a hormone found naturally in the body that, among many other functions, increases the body’s ability to clot. Therefore, increased exposure to estrogen has been associated with a higher risk of blood clots — a rare, but serious condition that can be fatal. Keep in mind, however, that for the average user, the patch is considered to be low risk and effective. So, figuring out which method of birth control is most appropriate for each person is best determined on a case-by-case basis with the help of a health care provider.

While the patch may expose the user to a higher level of estrogen than the pill (about 60 percent more in some cases), research indicates that other behavioral and medical factors in a person's life tend to play a more significant role in causing blood clots. For example, pregnant people are at least two times more likely to get a blood clot than non-pregnant people taking oral contraceptives. Furthermore, many of the studies that indicated an increased risk of blood clots for people using the contraceptive patch (as compared to people using other forms of contraception), didn’t consider additional risk factors for blood clots (such as body mass index, smoking, etc.). So, it's possible that the users of the patch in those studies may have had other factors that predisposed them to blood clots in the first place. In any case, there are a number of people who are advised not to use the patch due to a higher risk of negative health consequences, one of those being blood clots. This includes those who:

  • Are over the age of 35 and smoke 
  • Have a history of blood clots or are genetically predisposed to them
  • Have previously had a heart attack or stroke
  • Have heart valve or heart rhythm problems
  • Have uncontrolled high blood pressure
  • Have migraine headaches
  • Have liver disease or tumors
  • Have unexplained vaginal bleeding
  • Are pregnant
  • Have had hormone-sensitive cancers (including breast cancer)

Signs and symptoms of a blood clot may include swelling, pain, tenderness, redness of the skin, difficulty breathing, and chest pain. If you experience any of these symptoms, the next best step would be to seek medical care immediately. Further, for those weigh more than 198 pounds, there is some evidence that it may be less effective. 

When prescribing birth control methods, it’s only after careful consideration of a person's current health status, medical history, and lifestyle factors that a health care provider deems a particular medication (in your case, the patch) appropriate for use. Even after your provider has written a prescription for you and you have begun to use the patch, it’s a good idea to periodically check in to discuss anything you've noticed since you started using the birth control method (i.e., side effects). Additionally, these check-ins may be a great time to bring up concerns or questions like the one you raised here.

Lastly, as far as the safest and most effective form of birth control, there are a number of methods that are approved by the U.S. Food and Drug Administration (FDA) and the patch is just one of them. For instance, there are estrogen-free options, such as the injection, progestin-only pills, condoms, and diaphragms. And like most options in life, every birth control method has its pros and cons. One method that is low risk and effective for you, may not be for another person. To learn more about the safety and effectiveness of other contraceptive methods, check out the Go Ask Alice! Contraception category.

Last updated Apr 03, 2020
Originally published Dec 09, 2011

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