This has been nagging at me since January. My roommate was hospitalized for the first week of the spring semester with pulmonary embolisms (yes, plural. She was lucky to survive). She was a smoker and was on NuvaRing. All the BC ads make it very clear that you should not smoke and take hormonal BC because of the risk of blood clots. And she's a med student, so she had to have known that was a risk. So I'm wondering why a doctor would have prescribed it for her? Why would a doctor knowingly prescribe a hormonal method to a smoker?
Posts: 59 | From: Anywhere, USA | Registered: Dec 2004
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There are a lot of risks that people take in spite of warnings to do otherwise. It's a choice that they get to make. One of my best friends is on the pill and (up until a couple of months ago) smoked regularly and she is well aware that it is not a good idea.
Your friend's doctor may not have been aware that she smoked when she/he prescribed the BC. Unfortunately, people are not always honest and open with their doctors. I have heard reports of some doctors who will prescribe hormonal methods for women who report only smoking occasionally and are under 35.
The hard thing here is that we can't actually know what caused the embolisms completely. The smoking and the BC may have contributed, but she may have had underlying risk factors that played a part as well. For sure, to be safest we would encourage all women on hormonal birth control to not smoke. They may have underlying risks that they are not aware of and the combination could lead to dangerous situations like your friend faced.
The WHO defines an "unacceptable health risk" for smoking and combined hormonal contraception in cases in which a woman is 35 or over and smokes more than 15 cigarettes a day. For women of that age who smoke less than that, the guideline is that the risks generally outweigh the benefits and most providers will try to prescribe an alternate method.
If your friend is under 35 and smokes any amount, it is in category 2, which states that the benefits generally outweigh the risks. So, her doctor was going by standard recommendations, and she was probably well aware of the risks and went in knowing it, like KittenGoddess said.
Of course, it is preferable not to smoke at all when using combined HBC, but the pregnancies they prevent also have a risk of blood clots every bit as high, not to mention the other health risks.
Posts: 4636 | From: USA/Northern Europe | Registered: Oct 2005
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