Researchers are warning women of the recently discovered potential risk of blood clots associated with the use of certain common pain relievers alongside hormonal contraception.
A comprehensive Danish study, encompassing data from two million women, has revealed that using ibuprofen, diclofenac (sold in SA under the name Voltaren among others), and naproxen (sold as Aleve in South Africa among others) while taking combined contraceptive pills containing both progesterone and oestrogen may marginally elevate the likelihood of developing blood clots. However, the study also indicated that women employing progestogen-only contraceptive methods, such as the mini-pill, implants, and coils, face a reduced risk in comparison.
The observed risk is low
While the observed risk remains relatively low, researchers advocate for greater awareness among women regarding the connection between non-steroidal anti-inflammatory drugs (NSAIDs) and hormonal birth control.
Among the NSAIDs identified with the highest risk factor – ibuprofen, naproxen, and diclofenac – three are among those most used in South Africa. Other NSAIDs prevalent in SA include celecoxib, mefenamic acid, etoricoxib, and indomethacin.
The research team harnessed national medical records to monitor instances of venous thromboembolism (blood clots) among two million women aged 15 to 49 residing in Denmark from 1996 to 2017, all of whom had no previous history of blood clots, cancer, hysterectomy, or fertility treatment.
More than half a million women
The study discovered that more than half a million (529,704) women using hormonal contraception also used NSAIDs. Ibuprofen was the most commonly used (60%), followed by diclofenac (20%) and naproxen (6%).
Over an average span of 10 years, just under 9,000 (8,710) venous clots occurred, with 228 (2.6%) of the affected women passing away within 30 days of diagnosis.
The research revealed that NSAID usage was correlated with an additional four venous thromboembolic events per week for every 100,000 women not utilising hormonal contraception. In women using medium-risk hormonal contraception, there were 11 additional events, while women using high-risk hormonal contraception experienced 23 additional events. Notably, the link appeared most pronounced for diclofenac when compared to ibuprofen and naproxen, though it’s essential to emphasise that the study didn’t establish a definitive causative relationship, but rather highlights the importance of informing women about potential risks.
The findings were meticulously analysed, taking into consideration various factors that could influence the results, including age, education level, pregnancy history, prior surgery, high blood pressure, and diabetes.
Dr Channa Jayasena, a clinical senior lecturer and consultant in reproductive endocrinology and andrology at Imperial College London, commented on the study’s significance, stating: “Contraceptive medications and painkillers like ibuprofen are essential for many women to avoid pregnancy and cope with period pain. But I don’t think this study alone should put off women taking either the pill, painkillers, or both if needed.”
