Of combined oral contraceptives, Covid-19 and blood clots

Combined hormonal oral contraceptives contain synthetic hormones; oestrogen and progesterone that are similar to the ones produced naturally by a woman. The ovaries produce these hormones to regulate the menstrual cycle including ovulation, menses and pregnancy.

The combined hormonal contraceptives work by thickening the cervical mucus to prevent movement of sperm and inhibit the ovaries from producing eggs. Typically, it mimics the pregnancy state where eggs are not released and when taken correctly, it is 99.9 per cent effective in preventing pregnancy and is totally reversible.

The risk

In one of her published articles, Dr Brigid Monda explains that the combined hormonal contraception pill can be safely used up to the age of 50 with careful monitoring in women who smoke or have risk of cardiovascular disease.

The World Health Organisation Medical Eligibility Criteria Wheel for Contraceptive Use 2016 warns that combined oral contraceptives are not to be used when a woman is battling cardiovascular diseases, including stroke, ischemic heart disease or multiple risk factors for the same.

Covid pandemic and contraceptive consumption

According to digital findings by Maisha Meds, 42 per cent of women who want to avoid pregnancy have an unmet need for contraception and 46 per cent of pregnancies are unintended in the East African region.

Additionally, there was a sudden significant disruption in sales of contraceptives in April 2020 in Kenya. However, the impact was short term as sales picked up in June 2020 irrespective of demand, price and brands in the market.

The United Nations Population Fund (UNPF) cautions that at a time when many countries health systems seem to be overburdened by the pandemic, the full toll of disruption in family planning is unknowable. Increased gender-based violence and early pregnancies may increase pregnancy-related complications, loss of life, loss of health and loss of dreams for the future.

Apart from such unusual aspects of the pandemic, the SARS-Cov 2 virus has grave pathological effects in the body. Apart from the documented effects on the lungs, kidneys and heart, there are reports indicating hypercoaguble state in Covid-19 patients with an abnormally increased tendency towards blood clotting even in previously healthy people, according to the Endocrinology journal.

This manifestation was evident among Covid-19 patients. Similar findings were published on the Elsevier Public Health Emergency Collection in July 2020.

Clotting is a natural process, but clots – the gel-like collections of blood that form in veins and arteries - can be dangerous when they do not dissolve on their own, according to vascular medicine specialist Meghann McCarthy.

“Birth control and hormonal therapy, in particular those containing estrogen may increase the risk of blood clots, although the absolute risk in the general population remains low. The thought is that hormones may affect some clotting factors produced by the liver, which in turn, can promote the development of clots,” she adds.

It is important to note that the chances are significantly low for women using progesterone-only containing pills, injections, implants and intrauterine devices and women with no prior clotting history. As highlighted before, Covid-19 has been associated with blood clot formation; however, the exact mechanism remains unclear. It is safe to say if you are on combined hormonal oral contraceptives, your risk for blood clots is elevated when you contract Covid-19. However, there are other combinational factors that contribute to the likelihood of blood clots in hospitalised patients, such as inflammation and injury to blood vessels.

Should you stop?

“For most women, including women who want to have children, contraception is not an option; it is a basic healthcare necessity,” says Louise Slaughter.

The Ministry of Health has continuously urged Kenyans to adhere to containment measures as cases of Covid-19 are indicative of third wave of the disease. It is advisable that women who use combined pill continue to do so as sudden cessation of contraception increases the chances of pregnancy.

If you wish to switch to other methods of contraception, seek advice. Since progesterone only and non-hormonal methods are suitable alternatives as they do not have evidence of increases risk of blood clotting, the degree of underlying health issues may make them worse when medical advice is not sought.

 The writer is a public health research scientist