The pills, other medical conditions and treatments

1- Blood clots: signs and symptoms and causes

Blood clots are thick clumps of blood that develop in response of an injury. Normally, it is a safe and natural response which prevents excessive loss of blood from your body. However, if it occurs without any injury, within a normal blood vessel or any organ, it may be lethal for your health. Unnecessary building up of clots in veins of your brain, neck or heart may lead to stroke and heart attack.

What causes blood clots to develop?

  • Immobility- those who have sedentary lifestyles, wheelchair users and those who undergone a surgical treatment are at higher risk of developing unwanted and harmful clots in various blood vessels and regions of your body.
  • High cholesterol and obesity may lead to clot formation.
  • There may be some medical treatments like chemotherapy and hormonal replacement therapy (HRT), and some medications like combined hormonal contraceptives may cause clotting of blood.

Signs and symptoms of blood clot

When a blood clot develops in a deep vein of your arm or leg, it is called deep vein thrombosis. Seek medical care immediately if you notice any of the following symptoms:

  • Swelling
  • Change in colour, may be red or blue
  • Pain- if it gets worsen it may hurt you
  • Warm skin
  • Laboured breathing- this means that your clot may have moved to your lungs, which may cause cough with blood.

If a clot has formed at around your heart, it may cause heart attack. Seek medical help if you see these symptoms:

  • Sweating
  • Difficulty in breathing
  • Severe pain in your chest and arm

How can I prevent a blood clot?

If you are in hospital or any medical setting, doctors will handle your condition by giving you injections that would thin your blood. However, if you want to avoid blood clots on your own, make these lifestyle changes:

  • Avoid sitting or being deskbound for long periods of time. Get up at regular breaks and stretch your body and walk around.
  • Consider avoiding combined pills and prefer minipills for contraception.
  • Stay hydrated and drink good amounts of water.
  • Avoid putting on excessive weight, increase your exercise.
  • On long trips like travelling through planes for hours, avoid long sittings, wear compression socks.

2- Breast cancer and the combined pill

When unwanted growth of breast cells occurs, it may lead to breast cancer. There may be several causes of breast cancer including gene mutations, family history of breast cancer, or may be some hormonal, environmental and lifestyle factors are involved in causing breast cancer. Among them, the most common cause of breast cancer is mutation in BRCA gene.

Which contraceptive put you at risk of breast cancer?

Research suggests that combined pills are associated with a high risk of developing breast cancer, chances are higher if you or anyone in your family had already been a victim of breast cancer.

Effects of combined contraceptive pills studied in a group of 10,000 women using combined pills for long periods of time, 54 developed breast and cervical cancer.

Why combined pill causes cancer and minipill is safe?

How a combined pill causes breast cancer is still unclear, but the hormone present in a combined pill called oestrogen may be the culprit. This statement is based on a fact that there is no case of breast cancer by the use of minipill (which lacks oestrogen) reported, to date. However, the research is still on the way to determine links between combined pills and breast cancer.

So, it is highly recommended that consult your GP or any expert clinician before starting combined contraceptive pills. Most importantly, if you are over age 35 and also have prior history of breast cancer.

3- Contraceptive pill and PCOS

Polycystic ovarian syndrome or simply PCOS is an endocrine disorder which is very common in women. It is estimated that about 6-12% women suffer with this disease.

In general, PCOS is manifested as with following symptoms:

  • Hyperandrogenism- androgens (growth hormones in men and women) are overly produced by the ovaries.
  • Ovulatory dysfunction- release of eggs from ovaries is either stopped or become infrequent.
  • Polycystic ovaries- ovaries increase in size and populated with multiple small cysts.

The patients of PCOS are generally presented as having following omplains:

  • Bloating and abdominal cramps
  • Pelvic pain
  • Weight gain
  • Acne
  • Irregular period
  • Surplus growth of hairs on fae and body

How PCOS is treated?

There is no ideal cure for PCOS so far. Very often this condition is managed and controlled by the use of contraceptives. The reason is, lack of ovulation in PCOS leads to the alteration in levels of oestrogen, progesterone, follicle stimulating hormone, luteinizing hormone and androgens.

Progesterone is found lower than usual, and androgen is found higher than usual amounts in people with PCOS. Therefore, birth control pills play important role in normalizing hormonal levels.

How contraceptives can help PCOS?

Hormonal contraceptives are considered as “first-line treatment” of PCOS. Birth control pills, ring, patch and coils can be prescribed to ease the symptoms of PCOS.

Oral contraceptives contain hormones oestrogen and progesterone which help in:

  • Regulation of menstrual flow
  • Decrease male hormones release e.g., androgens
  • Manage hyperandrogenism like lowering acne and extra hair growth
  • Decrease the chances of ovarian cancer and endometrial cancer

If you stop taking contraceptives during PCOS, your periods may become irregular again. PCOS may interfere with your pregnancy making it difficult to occur.

If you are choosing contraceptives as treatment for PCOS, discuss it with your GP or visit our health hub contraceptive clinic for more assistance.

4- How does the pill affect your sex drive?

If you are on contraception and facing problems during sexual activity (libido), this may be an effect of contraceptive option. Combined pill is believed to be associated with reduced sex drive.

Which hormone is involved in stimulation of sex drive?

 Testosterone is the hormone which induces the urge for sex. Female hormones present in combines pill may decrease the levels of testosterone, leading to lower sex drive.

The pill may do so by causing vaginal dryness and you become reluctant of doing sex.

If you feel that your sex life is getting affected by the use of contraceptive, talk to your doctor. But, don’t stop taking contraceptive straight away, because this may result as pregnancy.

5- The pill and acne

If you are in adult age and notice tiny bumps on your face, neck and shoulders, then you are having adult acne, also called hormonal acne. This is the most common skin disease around the world that mostly hit women. This acne may be observed as pimples, white and black heads, and minute cysts.

Causes

The blockage of hair follicles in the skin is the most prominent cause of acne. This blockage occurs due to accumulation of an oily substance sebum and dead skin cells, causing the follicles to swell up. Sebum is produced by sebaceous gland attached with hair follicles. Normally, sebum helps in hydrating skin and hairs, but in excess amounts sebum may block hair follicles leading to growth of acne.

Why it is called hormonal acne?

Release of sebum from sebaceous glands may get influenced by certain hormonal levels, that’s why it is called hormonal acne. Hormones that increase sebum production and are responsible to cause acne are:

  • Testosterone- raising levels of testosterone in puberty in young adults stimulate sebaceous glands to produce more sebum. As a result, blockage of follicles occurs and acne flares-up.
  • Male hormones, and androgens may be responsible to cause acne in women. Polycystic ovarian syndrome is the condition in which these male hormones increase in women’s body. This acne mostly develops before periods, menopause and in first 3 months pregnancy.

Symptoms

Hormonal acne can be manifested as damaged, inflamed, and painful skin lesions on your cheeks, neck, shoulder and chest.

Treatment

Mild and moderate acne can be treated by topical creams, gels and face washes that contain benzoyl peroxide or salicylic acid.  In severe cases, your doctor may prescribe antibiotics and combined contraceptive pill for the treatment.

Why combined pill is suggested for acne treatment?

Because combined pill helps to normalize hormone levels and controls outbursts of acne. The commonly used combined pills that are licensed to be sold for the treatment of hormonal acne include:

  • Co-cyprindiol is the generic name of combined pill, which aids in lowering the hormone levels that cause building-up of sebum in hair follicles, and thus lead to acne. Co-cyprindiol is mostly sold as its branded versions Dianette or Clairette.
  • Luccette is the generic name of combined pill which is sold as Yasmin. It is a well-known contraceptive but may be prescribed for the treatment of acne.

Progesterone only pill or implant cannot treat acne as they may increase levels of male hormones. Rather, acne gets worst by the use of minipills.

References

Hormonal Acne. What it is?

Blood Clot Symptoms: How to Tell if You Have One

Does the contraceptive pill increase cancer risk?

What is breast cancer? An expert explains

BRCA1 and BRCA2