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. More to your line of questioning, the concern that's been raised with the Ortho Evra (a.k.a. the patch) has to do with the amount of estrogen, a hormone found in many contraceptives, a user is exposed to when using the method. The patch exposes a user to about 60 percent more estrogen than if they were taking certain birth control (BC) pills, particularly formulations that contain 35mg of estrogen. In general, estrogen tends to thicken the blood and an increased exposure to it has been associated with a higher risk of blood clots — a rare, but serious condition that can be fatal. For average, healthy users, the patch is considered to be safe and effective. However, there are a number of health-related factors and conditions that further impact the likelihood of blood clots and other serious conditions with the use of the patch (read on for more on those factors). And, when it comes to figuring out which method is the safest for each person, this is best determined on a case-by-case basis with the help of a health educator and a health care provider.

While the patch may expose the user to a higher levels of estrogen than the pill, research indicates that other behavioral and medical factors in a woman's life tend to play a more significant role in causing blood clots. Some studies have indicated that there is an increased risk of blood clots for women using the contraceptive patch (as compared to women using other forms of contraception). However, none of the studies took factors such as body mass index (BMI), smoking, and medical history — all known risk factors for blood clots — into consideration. So, it's possible that the users 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, including those who:

  • Are over the age of 35
  • Smoke
  • Are obese
  • 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)

It's also good to keep in mind that it is 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) safe and appropriate for a specific person. Even after your provider has written a prescription for you and you have begun to use the patch, s/he will also want to periodically check in to see how well it's being tolerated and assess risks for various health conditions. These check-ins are a great time to discuss any concerns you might have or talk about anything you've noticed since you started using the method.

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) (a governmental agency in the United States responsible for ensuring the safety and effectiveness of human drugs), and Ortho Evra is just one of them. Beyond that, each method has its pros and cons. And, while a method may be safe and effective for you, that might not be the case for another person. To learn more the safety and effectiveness of other contraceptive methods, check out the Go Ask Alice! Contraception archives.


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