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Does having factor V Leiden increase the risk of thrombosis while on oral contraceptives?

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Posted on Mon, 14 Dec 2015
Question: I have Factor V Leiden Heterozygous and I am wanting to get on birth control. No blood clot history. I was on the pill for years before knowing I had Factor V. My mom found out she did, so I got checked. I just recently had the non-hormonal Paragard IUD put in for this reason, but I just had my first period and it was awful. I know it can cause heavier bleeding and more cramping which I've definitely had. I've been light headed and nauseous at times. I had a baby 3 months ago. I had heavier periods prior to pregnancy, so I'm wondering if this just isn't right for me. I know it can get better, but I can't go on monthly feeling this way until then. so my question is, we don't want to use condoms and I did some research on progestin only birth control being OK for ladies with blood clotting issues as it's the estrogen that causes the increased risk. so, Could I safely use one of the progestin only options? I want to be safe, but feel good too. I could take a daily low dose aspirin possibly as well? I'm going to talk to my OBGYN and regular doctor as well, but want multiple opinions.
doctor
Answered by Dr. Panagiotis Zografakis (47 minutes later)
Brief Answer:
probably safe

Detailed Answer:
Hello,

being heterozygous for Leiden factor does increase your risk for thrombosis but only mildly so. Using progestin only contraceptives (mini-pill) may increase the risk further but not that much to make a big difference. Adequate studies are lacking regarding this subject but although there seems to be a slight increase in the risk, the absolute risk seems to be comparable to individuals not taking the mini-pill. So, for someone without a history of thrombosis it's probably not contraindicated. Please remember that smoking increases the risk for thrombosis, particularly with concurrent contraceptive use. Also the higher the age, the higher the risk. The risk for a 20 years old woman is much lower than the risk for a woman at her 40s.

Kind Regards!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Panagiotis Zografakis (3 minutes later)
I don't smoke and I just turned 32. What about Mirena or Implanon? Same? What if I took a daily low dose Aspirin, could that lower the risk?
doctor
Answered by Dr. Panagiotis Zografakis (10 minutes later)
Brief Answer:
it's the same...

Detailed Answer:
Although not enough studies are available, the risk seems to be low for every progesterone only contraceptive method. The risk is higher for every method but the absolute risk is not high enough to be considered unsafe. I'm not aware of any studies addressing the aspirin issue. Aspirin is supposed to reduce thrombosis by preventing the formation of platelet clots. Leiden factor is involved in the coagulation cascade which is a different system, but aspirin may still provide some benefit. There is no therapeutic indication for this purpose though. Low molecular weight heparins are indicated for various causes of thrombophilia but factor V Leiden (heterozygous) is not one of them.

Kind Regards!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Panagiotis Zografakis (7 minutes later)
Is Ibuprofen considered safe with Factor V as well?
doctor
Answered by Dr. Panagiotis Zografakis (4 minutes later)
Brief Answer:
the same applies here

Detailed Answer:
NSAIDs like ibuprofen may increase the relative risk but the absolute risk is still low for a heterozygous Leiden individual without any prior thrombotic event. So, although their use should be avoided for various reasons, there's no absolute contraindication.


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Panagiotis Zografakis

Internal Medicine Specialist

Practicing since :1999

Answered : 3767 Questions

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Does having factor V Leiden increase the risk of thrombosis while on oral contraceptives?

Brief Answer: probably safe Detailed Answer: Hello, being heterozygous for Leiden factor does increase your risk for thrombosis but only mildly so. Using progestin only contraceptives (mini-pill) may increase the risk further but not that much to make a big difference. Adequate studies are lacking regarding this subject but although there seems to be a slight increase in the risk, the absolute risk seems to be comparable to individuals not taking the mini-pill. So, for someone without a history of thrombosis it's probably not contraindicated. Please remember that smoking increases the risk for thrombosis, particularly with concurrent contraceptive use. Also the higher the age, the higher the risk. The risk for a 20 years old woman is much lower than the risk for a woman at her 40s. Kind Regards!