Nicole Bryla was a student at the University of Texas who, while jogging down Main Street in the town of Fredericksburg, suddenly collapsed and died. The cause of Bryla’s death? A pulmonary embolism, a condition caused by blood clots that form in the legs and travel to the lungs until they block arteries. Nearly ten percent of people with this condition die within the first hour of its onset. After many tests, doctors linked Bryla’s death to her birth control pill.
“The pill is the number one birth control method we prescribe,” said Barbara Jastran, Clinical Counselor RN, MSW at Gannett Health Center. In recent years, the number of women using the pill has risen. Why? Because it is easy, convenient, reputable, and has a 99.9 percent rate of success. Many women are using the pill, and nearly none of them have experienced the complications Bryla faced.
An article in The New England Journal of Medicine, entitled Oral Contraceptives and the Risk of Venous Thrombosis (2001) reviewed several studies which concluded that women on the birth control pill are three to six times more likely to get venous thrombosis. The article explained, “The absolute risk, however, remains low. A base-line risk of less than 1 per 10,000 person-years is increased to 3 to 4 per 10,000 person-years during the time when oral contraceptives are being used.”
Simply put, venous thrombosis is an incredibly rare affliction whether on the pill or not. “What [Bryla] had is not new. Pulmonary embolism was understood the day the pill rolled off the presses,” said Dr. Susan Miller, physician at Gannett. “Technically, there are risk factors. Sometimes there aren’t any. For example, an obese female is already at risk of developing a blood clot.”
The birth control pill is not for everybody. Jastran meets with women each day who are searching for a suitable method of contraception. Jastran never blindly suggests the pill — instead she spends time exploring all the options and examining the woman’s past medical history along with themedical history of family members.
“I go through options of preventing pregnancy with them…What is their most important need? It may be total spontaneity, no interruptions, so the condom is not the right choice,” Jastran said.
Choosing contraception is an extremely individual process. Some women dislike hormone treatment and prefer the rhythm method supplemented with a condom. Other women hate swallowing pills and would rather receive hormonal shots every three months. It is Jastran’s job to explore all the options from vaginal spermicides to the NuvaRing. From a chart with over ten options, there is something to suit a variety of needs.
Many women are not aware of the recent additions to the hormonal methods of pregnancy prevention. Along with the pill, there is now the patch (Ortho Evra), the ring (NuvaRing), and the shot (Depo Provera).
The patch, which resembles a nicotine patch, is worn for a week at a time, three weeks each month. The medication is absorbed through the skin; because of the direct hormone flow into the bloodstream, the patch works for women who suffer from eating disorders such as Bulimia. A common side effect is breakthrough bleeding.
The ring looks like a rubber bracelet, and is inserted into the vagina for three weeks at a time. It dispenses the necessary hormones into the woman’s system.
The shot is one dose that lasts three months. It results in menstruations that are different from the pill, patch and ring. Sometimes women on the shot may not get their period for a long time. Those who use the shot for more than three years often develop problems with bone density, because the shot injects progesterone, not estrogen, into the woman’s body.
These less traditional yet more convenient methods are popular among women who forget to take their daily pills. Although there are side effects for nearly every prescription birth control method, the majority of patients who have a normal period have about ten options from which to choose. The pill’s main advantage is its ability to vary hormone levels.
“On the patch you can’t vary. There is one composition. With oral contraceptives, if you are on it for three months and there are still side effects, then we see if there is too little estrogen, too little progesterone, or too much of something…the adjustment is based on a specific objective,” said Miller.
Despite the meticulous medical thinking that goes into choosing the correct birth control method, many women do not treat the pill, patch, ring, or shot as a drug.
“Some people don’t see the pill as medication. If their doctor asks them if they are on medication, they say no, even if they are on the birth control pill,” said Jastran. It is important for women to remember that the pill is a drug with side effects.
“Being on the pill has risks and a lot of women don’t take it seriously. The likelihood of a problem is small, but you have to report problems if you see them,” said Miller. For instance, women should never be on the pill around surgery, because immobilization of the body may lead to blood clots.
Another factor women must remember is that the birth control pill prevents pregnancy only. It does not protect against sexually transmitted infections.
“College women think about pregnancy, and they don’t think beyond pregnancy. There is a much bigger picture than just getting pregnant,” said Jennifer Austin, communication specialist at Gannett.
Gannett offers many services to help women confront issues relating to birth control and STI prevention.
“Gannett helps focus on all risks. There is a whole educational process in learning what an acceptable risk is for you,” Austin said.
“We carry all options that any private doctor or family planning center would. We are in the business of prevention. We are working with the young population without telling them what to do, but they have to tell us if something isn’t working,” said Jastran.
“People should come in and get information if nothing else. It might lead more women to choose something,” Miller concluded.
Archived article by Jessica Liebman
Sun Staff Writer