New Birth Control Restrictions Could Be Overkill

France is considering restricting some pills due to blood clot risk, but one expert says that’s not a good path for the US.

A woman holds a birth-control pill at her home in Nice, France, January 3.

Image by Eric Gaillard / Reuters

A French regulatory agency has called for stiff restrictions on some newer birth control pills because they carry a higher risk of blood clots than older contraceptives. The country’s healthcare system will stop reimbursing patients for the pills — third- and fourth-generation brands containing certain synthetic forms of progesterone — in March. And regulators want to require that the pills be prescribed by a specialist (rather than a gynecologist or family doctor), and never to first-time birth control users.

The FDA has also issued a warning last year that some newer birth control pills, including Yaz, confer a higher blood clot risk than older varieties. But adolescent health specialist Dr. Atsuko Koyama says the French restrictions aren’t necessarily a good idea. She points out that the risk of clotting for girls and women on the newer pills is still low, about 6-7 clots per 10,000 women per year, compared with 3-4 per 10,000 on the older forms. The risk of clots during pregnancy is somewhat higher, 6-12 per 10,000; and in the first three months after giving birth, it rises to 40-65 per 10,000.

She wouldn’t necessarily prescribe Yaz or its analogues as a first choice — for teenagers, many experts now recommend longer-acting methods like implants or IUDs. And “if you have certain characteristics, like if your mother had a blood clot, I am more wary of prescribing you something that’s going to increase your risk.”

But “every woman has a different reaction to every pill,” and for some women who have experienced spotting or other side effects with older pills, the newer ones may be appropriate. Also, the risk of blood clots for the new pills is highest in the first three months to a year of use, so if a patient has taken one with no problems for years, Koyama usually wouldn’t advocate switching.

The American College of Obstetricians and Gynecologists agrees. In a statement released last year on pills like Yaz that contain the progesterone-like chemical drospirenone, the group said, “Birth control pills containing drospirenone may have a slightly higher risk of blood clots than other oral contraceptives (OC), but any increased risk remains very low […] Women taking OCs containing drospirenone and doing well on them do not need to stop taking them.”

Ultimately, Koyama says, reducing the number of pills available isn’t good for women — they should be able to talk about risks and benefits with their doctors and make a decision that works for them. “As a physician,” she says, “I need to have all the different kinds of birth control available for my patients.”