A contraceptive pill left this woman with two blood clots and a collapsed lung.

April 8, 2015

Emma Dickson was just one month away from marrying the love of her life, Dougie, when her left lung collapsed.

The 31-year-old was rushed to hospital in Ireland, where doctors discovered she’d developed two blood clots in her pelvis that had then moved into her lungs, triggering a serious medical condition. Doctors were also concerned that a clot could have moved into her brain, triggering a stroke.

“All my plans of a beautiful wedding suddenly seemed so trivial, and I was actually thinking of what I wanted to happen at my funeral,” the home care nurse tells The Daily Mail. “I texted Dougie to say I loved him because I genuinely thought I wasn’t going to make it. It was a horrible conversation to have.”

According to doctors, Dickson’s blood clots were likely caused by the combined oral contraceptive Pill she’d been taking for more than a decade. This shocked Dickson, because the popular Clairette pills had never given her any side-effects in the past.

“You take the Pill to help you, to keep you responsible. You never imagine you’re going to end up with a collapsed lung and planning your funeral,” Dickson says. Thankfully, it didn’t come to that — doctors were able to dissolve Dickson’s blood clots and reinflate her collapsed lung, and her wedding went ahead in Edinburgh as planned.

Emma and Dougie at their wedding (via Facebook)

Dickson's experience is certainly nightmarish, but it shouldn't make you uneasy about using the Pill. Blood clotting — also known as deep vein thrombosis, venous thromboembolism and pulmonary embolism — is considered a dangerous, yet very rare side-effect of the combined pill, which contains a combination of oestrogen and progestogen.

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"Combined pills do increase the risk of blood clots in all women who use them, but that absolute risk is very, very small," says Dr Deborah Bateson, Medical Director of Family Planning NSW. Evidence suggests this risk is increased around two to three times in combined pill users compared to non users, with a baseline rate of ten women per 10,000 affected per year. It's important to put these figures in perspective.

"For most women of reproductive age who are taking the Pill that risk is extremely low; in fact, much lower than the risk of blood clotting in pregnancy or immediately after delivery," Dr Bateson explains. "There's a risk of a spontaneous blood clot in all non-Pill users as well."

The risk of blood clotting among users of the combined pill is effected by the level of oestrogen in its formula. Since the Pill was introduced in Australia, this dose has been gradually reduced from its original higher levels. Dr Bateson says the low-dose Pills available today are a very safe formulation, and despite reports to the contrary, research is yet to determine whether certain brands are associated with a higher clotting risk.

"There's no firm evidence to suggest that [among] the low-dose Pills on the market, any particular formulation necessarily has a higher risk. We don't selectively prescribe — if a woman is eligible to use a method with oestrogen, she can use any of the Pills that are on the market," she explains. (Post continues after gallery.)

Popular forms of birth control

Contraceptive pillThe Pillis the most popular form of birth control. There are two types: the combined pill, containing two hormones, and theprogestogen-only, or mini, pill, which only contains one female hormone. The combined pill works by preventing the ovary from releasing an egg each month. The mini pill changes the mucus at the entrance of the uterus, which stops sperm from entering. Both are 99.7% effective; however, they don't offer protection from STDs.

Intrauterine deviceIUDs are small, T-shaped devices that are inserted into the uterus by a doctor in order to prevent pregnancy. There are two types of IUD: copper, which affects the movement and survival of sperm in the womb while changing the lining of the womb;and hormonal, which releases progestogen (a synthetic version of the naturally-occurring hormone progesterone) into the uterus. Although IUDs have a success rate of more than 99%, only around 2% of Australian women currently use one.

CondomsThe male condom is a barrier contraception that prevents both pregnancy and the transmission of STDs. They work by collecting semen so it doesn't enter theman's partner's body. Condoms are 95 to 99% effective at preventing pregnancy.

The female condomThe female condom is a pre-lubricated sheath, which loosely fits inside of the vagina. The condom has a removable ring, which helps to insert the sheath and keep the condom in place. A larger ring remains on the outside to cover the opening of the vagina. They are designed to fit all women and can only to be used once. Due to misuse of the product it is only 79 per cent effective.

DiaphragmLike the male condom, the diaphragm is a barrier method of contraception. It's a shallow silicone dome that's inserted into the vagina andcovers the cervix, which is the entrance to the uterus. It's held in place by the pelvic muscles, and works by preventing sperm from entering the uterus. After sex, diaphragms need to remain in placefor another six hours, in which time the sperm inside the vagina die. This method is 88 to 94% effective at preventing pregnancy, although this rate increases with experience.

Birth control implantThis is a 4cm-longimplant that is inserted into a woman's upper arm, just under the skin, by a doctor. It releases a hormone called etonogestrel, which prevents ovulation and thickens the mucus in the cervix, which can stop sperm from entering. Contraceptive implants - usually sold as Implanon - are removed under anaesthetic every three years, and are close to 100% effective.

Vaginal ringVaginal rings are soft plastic rings that contain the same two hormones as the combined pill - oestrogen and progestogen. The ring is inserted into the vagina, where the hormones are absorbed into the body and then prevent the ovaries from releasing eggs. Once inside the ring can't be felt, and it needs replacing every three weeks (with one week's break in between). When used correctly, this method is more than 99% effective.

Depo ProveraDepo is a long lasting hormonal injection. The synthetic form of progesterone is administered every 12 to 14 weeks to woman, preventing pregnancy within this ongoing time period. The injection, which is given in the buttock or muscle of the upper arm, prevents ovulation and thickens the mucus in the cervix, helping to block sperm. The injections are 99 per cent effective but do not protect against STDs. Male contraceptive injections are currently being trialled

The morning after pillEmergency contraception (popularly referred to as the morning after pill) is used to prevent a pregnancy following unprotected sex. Other reasons include missing a contraceptive pill or a condom breaking. It is common in Australia to use the progestogen-only method. This entails a dosage of EC pills containing progestogen or the synthetic version. A doctor can prescribe the pill or they can be bought over the counter at a pharmacy without a prescription. Emergency contraceptionis 85 per cent effective in reducing the risk of pregnancy.

SterilisationSterilisation is a permanent form of contraception. For women there are two types of sterilisation: tubal ligation, in which clips are placed on the fallopian tubes, or tubal occlusion in which a device is inserted into the tubes. These methods work by preventing the sperm from reaching the egg. Tubal litigation is 99.5 per cent effective. The Vasectomy (for men) works by cutting and blocking the tubes called the vas deferens, preventing sperm from leaving the testicles. The chances of impregnation with a vasectomy are 1 in 1000.

The combined pill isn't the only contraceptive method that contains oestrogen — the vaginal ring, or Nuvaring, is associated with the same risks and side effects as the Pill.

Although the risk of blood clots is low for most women who use oestrogen-based birth control, there are factors that can make them unsafe for some women. These factors include past experience with a blood clot, a strong family history of clots, or a mutation that increases susceptibility to developing one.

For this reason, it's important for GPs to take a good family history before prescribing birth control; it's rare that an existing risk factor won't show up in a woman's family previously. Dr Bateson says there are a few other blood clot risk factors that make some people ineligible to use the combined pill or vaginal ring.

"Someone who's immobilised, for instance, as we know blood clots can be associated with a lack of movement; and also people who are very overweight as well," she says. Smoking and age are also viewed as risk factors — doctors generally stop prescribing the Pill for women when they reach the age of 50.

The good news is, there are several alternatives available for the small number of women who can't use oestrogen contraceptives. There are progesteron-only methods, like the hormonal intrauterine device (IUD) and hormonal implant, or methods that contain no hormones at all, like the copper IUD. If you're concerned about the risk of blood clots, make an appointment to talk through your birth control options with a GP, or give the Family Planning Talkline a call, before taking any action independently.

"What we don't want is for people to feel anxious, or not know where to turn for help, and suddenly go off their method of contraception and have an unintended pregnancy," Dr Bateson says.

"For those women who are choosing the Pill, it's a very, very safe option indeed that's been used for a long time. We're certainly happy to prescribe the Pill for women when we've taken a good family history and we know they haven't got those additional risk factors for blood clots."

For Emma Dickson, treatment for her blood clots is ongoing. She will need to inject herself with blood-thinning medication for the rest of her life, and is unable to continue using any medication containing oestrogen.

"The blood-thinning medication I am now on causes severe headaches, nose bleeds, hair loss, nausea and extreme fatigue. If I want to have a family, I will have to switch medication and inject myself on a daily basis, because my current medication can cause birth defects," she said.

However, Dickson is quick to point out that her experience shouldn't scare other women off the Pill.

"The risks are in the leaflet. It's just a remote possibility. There is nothing wrong with the Pill. I just did not think it would affect me."

For more information about the Pill and blood clots, read this Family Planning NSW fact sheet.

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