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karrot305 - September 17th, 2008 10:50 PM

hi Dr. Jacobs- we've been having this discussion over on the Lovenox and Pregnacy thread under female infertility- so most of us have blood clotting disorders of some sort and after successful pregnancies with the help of lovenox, we are wondering what birth control methods are safe. obviously barrier methods would be, but is there anything else that is an option- in particular norplant or IUDs? dont even they contain hormones like levonorgestrel that can increase the risk of a clot? I know youre in the business of getting people pregnant and not avoiding it- but if you could give us your opinion it would be appreciated. My OB pretty much said diaphragm or condoms only!

(new topic not working, only new poll)

B. Jacobs, M. D. - September 18th, 2008 6:39 AM

The problem with birth control pills is that they contain a potent synthetic estrogen. Everything absorbed from your intestine goes straight to your liver. Estrogens stimulate the production of all kinds of proteins by the liver, including clotting factors. Any contraceptivetechnique which does not invovle swallowing an estrogen should be relatively safe from the standpoint of your clotting disorder.
Good luck.

karrot305 - September 22nd, 2008 8:50 AM

thanks for your reply, I was out of town all weekend, but now realize I have a f/u question- so if estrogen po is the big risk for clots, why is the patch so dangerous that my OB won't give it to ANYONE, clotting disorder or not? and even the FDA says it carries a greater risk than the pill. so it seems even cutaneous/subcutaneous/intra-uterine absorbtion of hormones should also be contraindicated in women with clotting disorders.
I just really want to know my risks before I ask for something that could get me in trouble- dont want my first clot to be my last! is there any BC besides barrier methods or sterilization that do not have ANY hormones but are still effective?

B. Jacobs, M. D. - September 22nd, 2008 4:39 PM

The FDA also claims that progesterone is dangerous for a pregnancy. OB-GYN's are concerned about doing something that carries an FDA warning. In truth the FDA does provide a lot of useful information, but I sometimes think they get a bit carried away. Always follow the recommendation of your physician. If he/she is overly cautious, that is OK. It is better to be too cautious than not cautious.
Good luck.

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