Stephan Moll, MD writes… Interesting and relevant publication this week [reference 1]. It is well known that estrogen–containing birth control methods (pills, vaginal rings, patches, injectables) increase the risk for DVT and PE. As women on blood thinners may have heavy menstrual bleeds, hormonal therapy may be considered to decrease the bleeding. Also, women on blood thinners may want to choose a method for contraception other than a progestin IUD (Mirena® IUD, Skyla® IUD).
The newly published study – a sub-analysis of the previously published EINSTEIN-DVT and EINSTEIN-PE Xarelto® versus warfarin studies – shows that the women who took contraceptives while on blood thinners (either warfarin or Xarelto®) did NOT have a higher rate of recurrent DVT or PE than women who did not take contraceptives.
Conclusion of the Study: Hormonal contraception may be used, if needed, by women with DVT or PE who are on blood thinners.
Practical Considerations: A good first consideration for a woman with heavy menstrual bleeding on blood thinners may be a progestin-releasing IUD [reference 2]. If that is not an acceptable choice or does not help decrease the heavy menstrual bleeding, then an estrogen-containing contraceptive may be a good next choice. A uterine ablation procedure can also be considered. Another option is the use of Lysteda® (= tranexamic acid), an oral medication that has been shown to decrease menstrual bleeding in women with heavy bleeding.
1. Martinelli I et al. Recurrent venous thromboembolism and abnormal uterine bleeding with anticoagulant and hormone therapy use. Blood 2016;17:1417-25.
2. Kiseli M et al. Comparison of therapeutic efficacies of norethisterone, tranexamic acid and levonorgestrel-releasing intrauterine system for the treatment of heavy menstrual bleeding: a randomized controlled study. Gynecol Obstet Invest 2016,Mar 8 [Epub ahead of print].
Conflict of interest: none
Last updated: March 30, 2016