Two fatalities linked to pill
Although birth control pills carry some increased risk of blood clots, doctors have been debating whether the newest-generation pills are any safer than their predecessors.
One of those new pills, a contraceptive called Yasmin that’s been available in the United States since 2001, is attracting particular attention because of reports that European users have suffered serious blood clots in the legs and lungs.
Like other combination pills, Yasmin contains forms of two female reproductive hormones, estrogen and progesterone. What’s novel about the pill is that it uses a new, synthetic version of progesterone that closely resembles the progesterone made by a woman’s body. Because it is chemically related to a diuretic called spironolactone, it also acts like a water pill and reduces bloating. And, like spironolactone, it helps lessen acne and oily skin.
Dutch authorities recently reported on five cases in which women taking Yasmin developed serious blood clots, one of which proved fatal. A 17-year-old collapsed and died after taking the pills for six months. An autopsy revealed she had suffered a pulmonary embolism, despite having no obvious risk factors, such as smoking, immobilization for a long period or plane travel. Although doctors never had a chance to test her blood, her parents tested negative for clotting problems.
The five Dutch cases were described in the Feb. 1 issue of the British Medical Journal. A 28-year-old suffered a leg thrombosis four months after switching to Yasmin; a 45-year-old had a deep vein thrombosis after two months on the pill; a 50-year-old had a similar thrombosis after three months on Yasmin, and a 35-year-old survived a pulmonary thrombosis after 17 days on the medication -- four months after she’d given birth.
They were among 40 European Yasmin users who suffered major clots -- two fatal -- first reported in the British journal in April 2002. That report led to several European warnings about the pill, manufactured by Berlex Laboratories, a unit of Germany’s Schering. The pill has been available in Europe since late 2000.
Dr. David Plourd, an assistant professor of obstetrics and gynecology at the Naval Medical Center, San Diego, said he was concerned that several of the Dutch women suffered clots so soon after starting the medication. “If they’d been on it for 10 years and then threw a blood clot, it’s less likely to be due to the Yasmin,” Plourd said. “However, we don’t know among how many women these 40 events occurred. So while I have a concern, there is no clear-cut evidence that this is a particularly less-than-safe or potentially harmful formulation.”
Dr. Philip Darney, chief of obstetrics and gynecology at San Francisco General Hospital, said he was unaware of any similar complications in this country. “We may not have had a broad enough experience with Yasmin in the U.S. to have seen any of this yet,” he said.
Because the risk of suffering a blood clot rises with higher doses of hormones, Darney said he hoped physicians and patients would be interested in several new contraceptive options, including the vaginal ring and an intrauterine device, which have “much lower doses than birth control pills.”
