When people get new prescriptions, they often don't look at the side effects.
That's what happened with a woman from Seattle who started taking a birth control shot. She became one of the less-than-one-percent who developed life-changing, life-threatening blood clots in her lungs.
Marilyn Wightman thought losing weight would ease her sudden mysterious shortness of breath in 2009.
It didn't. Then, she fainted on the stairs.
"The first question my doctor asked was, 'Are you taking Depo-Provera?' I'm like, 'Yeah.' And he's like, 'Oh, that's it,'" Marilyn explains.
He put her on blood thinners, but she was in and out of the hospital until last year when her doctors told her that, without surgery, she had a ten percent chance of living five years.
"In a very small fraction, however, patients develop a response to the clot, where the clot breaks down, but then you start to develop scar-like plugs that obstruct the vessels and make it harder and harder for the blood to be pumped through the lungs," explains Michael Mulligan, MD, of Cardiothoracic Surgery at UW Medicine.
In a six-hour procedure that left a scar, Mulligan removed 15 clots mixed with scar tissue from Marilyn's lungs.
First, he had to raise her oxygen level, then lower her temperature and metabolism, stop her heart and drain her blood.
"You work very quickly to expediently tease out these clots that are multibranched without puncturing the vessel, which is wafer thin," Mulligan explains.
Marilyn says she wouldn't have taken Depo-Provera if her doctor had told her about the blood clot risk.
"So, I'm telling my story because I want at least one woman to ask the question. When your doctor is trying to give you a new drug, ask the question. What are the side effects?" Marilyn says.
Mulligan says as long as Marilyn stays on her blood thinners, her clots should not return.
And it shouldn't be long until she has her normal life back again.
BLOOD CLOTS AND BIRTH CONTROL
BACKGROUND: Some types of birth control, but not all, are linked to clotting problems. Blood clots are rare, even among birth control users. The rate for getting clots is about 0.3 percent to one percent over ten years for a woman on the pill. A woman is much more likely to have blood clots during or after pregnancy which can cause serious health problems. Clots in your legs, lungs, or brain can be especially dangerous. A clot in the vessels moving blood up from your legs is called deep vein thrombosis (DVT). It can break off and travel to the lungs. A clot in the vessels that bring blood into your lungs is known as a pulmonary embolism (PE). PE can be deadly because it could stop blood from getting to your lungs. Birth control pills as well as patches, rings, and some IUDs use hormones to prevent pregnancy. That's usually estrogen or progestin or both. Estrogen is most closely linked to blood clots.
BIRTH CONTROL METHODS WHICH MAY CAUSE BLOOD CLOTS:
Studies show that combination oral contraceptives can raise your odds of getting blood clots. The chance of clots is 2 to 6 times greater among women taking the pill vs. women who don't use birth control. Progesterone-only oral contraceptives, also known as the mini-pill, has only one hormone, progestin, and the dose is very low. You're no more likely to get a blood clot than women who don't take birth control. Contraceptive pills with drospirenone, a kind of progestin but unlike other types of progestin, may make you more likely to get clots. The ring gives a steady dose of hormones, both estrogen and progestin. Compared to women who don't use birth control, those using the ring are 6.5 times more likely to have blood clots. The risk of the patch is greater than other types of hormonal birth control and for every woman not using birth control who gets a blood clot, eight women who use the patch will. Only birth control methods with hormones may raise your chance of blood clots. Barrier methods such as condoms and diaphragms do not. Neither do medical sterilization procedures, like getting your tubes tied.
GROUNDBREAKING RESEARCH ON BIRTH CONTROL:
A groundbreaking intravaginal ring developed by Northwestern Medicine biomedical engineer Patrick Kiser, Ph.D., protects women against HIV, sexually transmitted disease and unplanned pregnancy. Now, he and his team have designed a new model of the ring that better controls the rate of drug release, enabling the delivery of a more diverse array of drugs for extended durations. In previous versions of the device, drugs were released into the body directly through the ring, which is made of a soluble polymer. In the new design, drugs are compressed into tiny pellets that are placed into a hollow tube inside the ring. The properties of the pellets control the rate in which the drugs are released. "By controlling the rate that fluid can get into the pellets, we control how fast the pellets swell and how fast the drug is released from the pellets," said Kiser, who is an associate professor of Obstetrics and Gynecology in the Division of Reproductive Biology and of Biomedical Engineering at the McCormick School of Engineering. The novel drug release mechanism can deliver multiple drugs with distinct chemical properties and dosing requirements simultaneously, a feature that may prove crucial as scientists and clinicians seek to optimize the potency of antiretroviral drugs and increase patient adherence to them.