A Danish study published in The BMJ shows that women using painkillers like ibuprofen, diclofenac, and naproxen along with hormonal birth control have a slightly higher risk of blood clots called venous thromboembolism (VTE).
The risk is higher for women using certain birth control pills but lower for those using progestin-only options like tablets, implants, and coils.
The researchers want to emphasize that the overall risk of a severe blood clot is still low, even if you use high-risk hormonal birth control. However, because many women use both these types of medications, they need to know about this potential interaction.
Researchers studied whether taking NSAIDs influences the risk of blood clots (venous thromboembolism) in healthy women using hormonal birth control. They looked at the medical records of 2 million women aged 15 to 49 in Denmark from 1996 to 2017, all of whom had no history of blood clots, cancer, hysterectomy, or fertility treatment.
They categorized hormonal birth control into high, medium, and low risk based on its known association with blood clots. High-risk options included specific patches, rings, and pills. Medium-risk options had the most combined pills and injections. Low or no-risk options included progestin-only drugs, implants, and intrauterine devices (coils).
The study considered age, education, pregnancy history, surgery, high blood pressure, and diabetes.
Among the women in the study, 529,704 used NSAIDs while on hormonal birth control. Most of them used ibuprofen (60%), followed by diclofenac (20%) and naproxen (6%).
Over ten years, there were 8,710 blood clots, with 2,715 pulmonary embolisms and 5,995 deep vein clots. Sadly, 228 women (2.6%) died within 30 days of diagnosis.
NSAID use was linked to a slight increase in blood clot risk:
- Four extra cases per week for every 100,000 women not using hormonal birth control
- 11 different subjects for women using medium-risk birth control
- 23 additional issues for those on high-risk birth control
Among NSAIDs, diclofenac had the most vital link to blood clots compared to ibuprofen and naproxen.
This study can’t prove causation, and there were limitations like missing data on smoking and obesity.
However, it was a large, well-done study that considered many factors. The results held up after further analysis, which makes them reliable.
In conclusion, the study suggests that women using high-risk hormonal birth control and NSAIDs, especially diclofenac, should be cautious.
The findings raise concerns, and healthcare authorities should consider them when assessing the safety of over-the-counter diclofenac. Women on hormonal birth control may want to consider alternatives to NSAIDs for pain relief or use lower-risk birth control options like progestin-only pills, implants, or intrauterine devices.
Journal Reference:
- Amani Meaidi, Annamaria Mascolo, et al., Venous thromboembolism with hormonal contraception and non-steroidal anti-inflammatory drugs: nationwide cohort study. The BMJ. DOI: 10.1136/bmj-2022-074450.