When preparing for surgery, many people wonder whether they should continue taking their birth control. This is a significant concern for both patients and healthcare providers, as the decision involves understanding individual health factors and the specific type of contraception used. Addressing this question requires careful consideration to ensure patient safety and optimize surgical outcomes.
The Primary Concern: Blood Clot Risk
Hormonal birth control, especially methods containing estrogen, can influence the body’s clotting mechanisms. Estrogen increases the plasma concentrations of various clotting factors. This elevation shifts the coagulation system toward a greater propensity for clot formation, and higher doses of estrogen tend to correlate with an increased risk of blood clot development.
Combined hormonal contraceptives are associated with an elevated risk of venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) in the legs and pulmonary embolism (PE) in the lungs. Users of combined hormonal contraceptives face a three to five times higher risk of VTE compared to individuals not using these methods, particularly during the first year of use. Surgery itself is also a known factor that increases the risk of blood clots, and prolonged immobility following a procedure further contributes to this risk. Therefore, the combination of hormonal birth control and surgery can present a heightened risk for these serious complications.
General Recommendations for Hormonal Birth Control
Combined hormonal birth control methods, such as oral contraceptive pills, skin patches, and vaginal rings, all contain both estrogen and progestin. For individuals using these types of contraception, medical guidelines generally advise discontinuation before elective major surgery. The typical recommendation is to stop these methods approximately four to six weeks prior to procedures that are major, involve the legs, or will result in prolonged immobilization.
The primary goal of stopping these contraceptives is to reduce the risk of venous thromboembolism, which is inherently elevated during and after surgical procedures. This timeframe allows clotting factors to normalize, as the increased blood clot risk largely subsides within two to four weeks after cessation. For minor surgeries with short anesthesia times, stopping birth control may not be necessary. If these methods are discontinued, it is important to use alternative contraception to prevent unintended pregnancy.
Different Birth Control Methods and Surgical Considerations
Other birth control methods have different surgical considerations. These include progestin-only pills, contraceptive implants, hormonal intrauterine devices (IUDs), and injectable contraceptives like Depo-Provera. Unlike estrogen-containing methods, progestin-only options generally do not carry the same increased risk of blood clots.
However, injectable progestins like Depo-Provera may have a small, elevated risk of thromboembolic events, particularly for those with existing risk factors. The copper IUD, a non-hormonal method, does not influence blood clotting. For individuals using these methods, stopping contraception before surgery is often not required due to their lower impact on blood clot risk. An individualized discussion with a healthcare provider remains important.
Collaborating with Your Healthcare Team
Before any planned surgery, consult with both your surgeon and the doctor who prescribes your birth control. These healthcare professionals will determine the safest course of action by considering several factors. They will evaluate the specific type and duration of your surgery, distinguishing between major and minor procedures, and whether it will be an inpatient or outpatient stay.
Your individual health history, including smoking habits, obesity, family history of blood clots, and other existing conditions, plays a significant role. The specific birth control method you use and its duration will also be part of their evaluation.
A personalized plan is essential, balancing the potential risk of blood clots against the risk of unintended pregnancy. Do not discontinue your birth control without explicit medical advice. In emergency surgical situations where stopping contraception is not feasible, doctors may use medications to prevent blood clots during the perioperative period.