Birth Control Blood Clots Deserve More Attention

Photographed by Kristine Romano

On Tuesday morning, federal health officials asked states to halt the use of Johnson & Johnson's one-dose COVID-19 vaccine. The reason: Six U.S. recipients developed a rare blood clotting disorder within about two weeks of receiving the vaccine, with one losing their life. Nearly seven million people have received the J&J shot, making this a very rare side effect. And while many experts say that this prudence is a good idea, folks on Twitter quickly started asking: Isn't birth control way more likely to cause blood clots than the J&J vaccine? And why is that okay again?

I’m all for safety but women have been getting blood clots from birth control for decades and they haven’t tried particularly hard to modify that
— Rebecca Fishbein (@bfishbfish) April 13, 2021

To put it in perspective, if 1,000 people were to use birth control pills for 10 years, you would expect approximately three to 10 of them to develop a blood clot — usually deep vein thrombosis (DVT) or pulmonary embolism (PE) — each year, according to Nancy Shannon, MD, a primary care physician at Nurx. "The risk of blood clots increases with an increased dose of estrogen," she adds.

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It's impossible to directly compare the J&J vaccine to birth control, however. They're different medications, and even the blood clots in question are different types that require different treatments. "It may be an immune response or reaction as opposed to the type of clotting we see with birth control," Abisola Olulade, MD, a San Diego-based physician, tells Refinery29. "That's the concern here, and that's why the CDC has recommended a pause."

I have a J&J appointment in an hour, and if I don’t get a vaccine because 6 people out of 6 million got blood clots after I was allowed — nay, encouraged — to take hormonal birth control for DECADES, you will be hearing about a tiny little one woman riot.
— Emily Dagger (@AbbottRabbit) April 13, 2021

It's also a good thing that officials are exercising an abundance of caution regarding the J&J vaccine, and calling for the pause. "Those six cases, it’s a little less than one in a million, it’s incredibly rare, but the agencies are hitting pause so they can look at the data and decide if the association is true," Paul Pottinger, MD, a professor specializing in infectious disease at the University of Washington School of Medicine, previously told Refinery29. It's a sign that our health agencies are taking safety very seriously.

But many on Twitter are left wondering why officials don't seem to take the blood clots — and other side effects, including depression, mood changes, increased or decreased libido, and acne — that can develop from hormonal birth control so seriously. "Birth control, in general, has a lot of side effects, and women have been enduring those side effects for years. They've been told it's in their head a lot of times and it's not," Dr. Olulade says.

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She says it comes down to the need for research. Right now, slowing the spread of COVID, which has killed almost three million people worldwide, is a top priority, and as such a ton of time and money is being poured into research — which has enabled the very quick and thorough development and testing of vaccines. That same urgency isn't seen around birth control. "If there's something that is working to a certain extent, then more often than not you don't see more innovation," Dr. Olulade says.

This underscores a larger, well-established pattern of sexism and bias in the medical field. People who are assigned female at birth are not equally represented in clinical trials, and their symptoms are not taken as seriously by doctors. The lack of attention paid to birth control side effects is just another example of how this bias plays out in real life.

Some experts argue that pharmaceutical companies may not be overly interested in exploring potential negative side effects of hormonal birth control. "I think it’s true that the companies who produce these pills are very willing to support proving that there are benefits to taking hormonal contraception," Professor Øjvind Lidegaard, who has studied hormonal contraceptives' effects on mental health, previously told Refinery29. "It is much more difficult to get support to study the negative reactions and demonstrate the adverse effects. Many more studies have been conducted to prove that [the pill] protects against ovarian cancer than that it can increase the risk of depression."

So while it's heartening to see the attention that's being paid to the COVID-19 vaccines, and while this scrutiny is critical, for many it has simply served to highlight an age-old bias in medicine: Developing better, safer forms of hormonal birth control seems to be a very low priority for scientists, doctors, and politicians — and there's no indication of that changing anytime soon.

I’m glad they are taking precautions re: blood clots & the vaccines. I would just really appreciate it if going forward they would keep that same energy re: women’s health & the undeniable correlation between birth control & blood clots.
— Leigh (@LeighMayock) April 14, 2021

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