OMG that's pretty bang on, esp the HR at running effort vs. RPE. I have a hard time cracking 145bpm but the RPE is waaaay too high. Hmm. Will mention it to GP.

AP

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"How bad could it be?" - SimpleS

I don't think anyone is trying to scare women away from BC pills, but I do think we as patients tend to be under-informed about the risks. Perhaps you've only seen two women in your practice with oral contraceptive-related blood clots, but in less than one day, we had three women post here with oc-related blood clots. Like I said in an earlier post, I personally know of five other women in the same situation, far exceeding the 1 in 10000 figure we're given. Add in some prominent women athletes who have publicly acknowledged oc-related blood clots, for example
Kikkan Randall, first American woman to win a XC World Cup race
Kim Smith, New Zealand distance runner record holder
Shawtinice Polk, Univ. of Ariz. basketball player who died of PE at age 22
a pro woman cyclist whose name I can't recall, also a woman pro triathlete

and it starts looking maybe a little less unusual. Still very rare, obviously, but maybe not as rare as it seems. Really, who knows what the rate is? Is their a reliable repository of these types of events? No. Yes, there are studies, but how comprehensive are they? Do they consider all possible risk groups? Have they studied women who might be at higher risk due to things like dehydration, frequent travel, low heart rate which allows blood to pool, etc., and if so, have they quantified those risk variables? We know that oral estrogen is related to hypercoagulability, we know that dehydration is related to hypercoagulability, we know that restricted movement (as in travel) is related to hypercoagulability. But do we know the combined effects? Is there no combined effect? Is it additive? Is it multiplicative? I don't think we know. I think a subgroup of highly trained women endurance athletes in any large-scale study would be so small as to never reach statistical significance. Given the potentially serious consequences (i.e., death), in the absence of comprehensive data, I think it's important that women be aware that there might be a few more things to think about. Don't flush your BC pills down the toilet, but don't ignore a funny pain in your leg that won't go away, or an odd inability to suck in enough air. If you're on BC pills, be particularly careful about hopping in your car for a 5 hour drive home after a race. If you don't need to be on the pill, don't be on it. Don't assume your doctor knows all this.

Not to be argumentative or anything. I guess I'm from the era that watched women's health issues be completely ignored and I clearly haven't recovered!

Great points. Thank god the BF is getting that vasectomy next month ;-) AP

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"How bad could it be?" - SimpleS

email me at: amccale at yahoo dot com

Have to agree. I don't think the goal is to scare women away from using bc pills but I'm not sure I would call the risk "astronomically small". And, regardless, women using the bc pill should be informed by their doctors and be well aware of the risk and what symptoms to look for. (And hope that their doctors aren't raging idiots like in my case but....). I think a little more information is warranted overall. Had I known the symptoms, there is no way in hell I'd have let things go on as long as they did. And, I think as athletes, we are used to things hurting here and there from time to time, things feeling a little "off", etc. that might go overlooked at times.

Thanks for all the posts everyone, although I'm starting to freak out a little. I was on Yasmin for a little over a year and just went off it (and any BC) last month. I have been having the same symptoms since Jan-- major problem runningm, biking not so much, swimming's been okay, but I also haven't been swimming too much so maybe I haven't noticed a difference. Anyways, I thought I had EIB/exercise-induced asthma, so went and saw an asthma, allergy, & respiratory specialist on Monday. I did a bunch of pulmonary function tests (PFT) before running, after running, before an inhaler, after an inhaler etc etc. Every PFT result was the same at around 90something percent. So I don't have asthma or EIB and the doctor couldn't figure out what was wrong with me. Just scheduled an appt w/ a pulmonary specialist he referred for Wednesday to check everything out.

Oh and Andypants, did you guys have any PFTs done, and if so, how were they?

Thanks again for all the info!

Yeah, I'm in the same boat as you...Been on the pill for more than 14 years and I am having lots of new asthma issues this season! EEEP!

I just looked at my pill and its the hormones ethinyl estradiol and norethindrone acetate. I take Estrostep Fe.

I had a cramp in my ribs under my right breast that wouldnt go away last night. It finally went away, but was painful and unusual.

We will see how the swim workout goes tonight. If theres any similar issues to the ones listed here I am on the phone tomorrow morning!

Thanks for bringing up this topic!

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Jeanne Roth
Team Timex 2007/2008
http://jeannejeannie.blogspot.com/

I haven't had a PFT or a VO2 max test since early 2005. I too always scored pretty high. But it's probably a good idea. First thing is to get into my GP and ask for tests on lungs. I know I don't have any exercise induced asthma as I don't get worse after the exercise ends (typical symptom of EIA).

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"How bad could it be?" - SimpleS

Add me to the list. Was on OC for 14 years with no issues and after having knee surgery in the summer of 2005 I ended up with a massive DVT (ankle to thigh) that required more than a year of Coumadin therapy plus weeks of Lovenox shots in the stomach and multiple trips per week to have my PT/INR levels checked.

My regular doctor definitely related it back to the OC and took me off of them immediately. My knee surgeon never once mentioned the risk of a blood clot so I was flying blind so to speak.

It's a very serious thing and one that I think women especially athletes should be aware of. No reason to be scared of OC just know the risks and do what you can to mitigate them.

I'm really pleased that I had a supportive husband who went in following the DVT and took care of that problem and who also rode with me while i was training for a 1/2 IM to make sure I didn't fall or get hit by a car since the risk of bleeding out from an injury while on Coumadin was very high.

Glad to hear you came through ok!

After my recent bout in the ER, I know my PFT scored pretty high. My d-dimer came back high, so I'll be following up with Internal Medicine shortly. Am also going off the pill in another month (after the BF's snip job). AP

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"How bad could it be?" - SimpleS

Sorry to hear about your d-dimer results Andypants (and everyone else that had/has blood clots) , hope you get it all figured out soon and are on the road to recovery!

Saw the doctor last week and he did a bunch of blood panels (including d-dimer, since I told him I was freaking out about possibly having a blood clot due to BCPs) and xrays. Everything came back okay, except I'm anemic-- my hemoglobin and hemocrit are very low, apparently so much so that I would be rejected as a blood donor. I had thought that the dizziness/getting lightheadedness when standing up was from the antibiotic I am (was) taking, and the fatigue was from my allergy meds... the only time I had trouble taking in enough air was during running, but this all makes sense now. So after more iron studies on my blood, and loads of iron supplements, the doc thinks I should be fine once my blood levels get up to normal. Regardless, I'm off the BCPs.

Just wanted to say thanks again for the post... I'd probably still be sitting around being depressed about my ever-increasing mile time.

:)

Hey that's great that you found out about your iron levels... keep us up to date on your improvements. You get running girl! ;-) AP

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"How bad could it be?" - SimpleS

I would think it's far more likely that the knee surgery caused the DVT than the OC. I'm surprised the doc never mentioned it as a risk, blood clots are a common risk after any surgery and are pretty common following ortho surgeries. In fact, many people are prescribed Coumadin as part of the standard treatment following a major ortho surgery to prevent clots.

I tend to agree with CatIsTriing that the risk is far higher that you'll get a DVT after travelling long distances to get to/from your races than OC. But maybe it's because I'm headed into the medical profession and I'm biased...

Really, I'm not arguing that oral contraceptives are more dangerous than traveling long distances. I would have to guess, though, that the combination of factors produces a higher risk than any single factor alone. Risk factors rarely work in isolation. Travel, dehydration, low heart rates, and surgery are all clot risks, which is why you read about endurance athletes, male and female, who have had DVT and/or PE episodes. My theory is that birth control pills, known to increase coagulability, just add a little more punch to the situation.

BTW, Kikkan Randall, the world class XC skier who recently had a scary clot episode, was found to have Factor V Leiden, a genetic disorder that increases the risk of clots. She probably shouldn't have been using hormonal birth control (NuvaRing, in this case), but testing for Factor V Leiden isn't routinely done until after there is a clot. Plus, she has something I've never heard of--May-Thurner Syndrome, which is described as a rare syndrome that occurs in young (rules me out) athletic women in which the left iliac vein is compressed by the artery crossing over it, thereby impeding blood flow. So, given all this, plus a high hematocrit, lots of travel, lots of intense exercise, and the occasional fall, the use of hormonal contraception was probably a really bad idea. This is not intended as a slam against the medical community (I LOVE my doctors!), but review of those factors does not routinely happen before birth control prescriptions are handed out. Doctors don't think about it, and we don't think about it. I certainly never did.

I might be having knee surgery, cross your fingers not, and I'm curious as to whether I should go off the BC pill for a month prior to surgery to lesson the possibility of a clot?

Also, a bit of a side track but I didn't want to create a separate post because of the subject, but has anyone every done a tubal ligation or other form on permenant BC? I've been on the pill for 21 years now and don't plan on having kids. I want to get some of the chemicals out of my body and artifical hormones are high on the list.

I'm assuming once I get off the hormones my risk of blot clots reduces, correct?

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Jen

"In order to keep a true perspective on one's importance, everyone should have a dog that worships him and a cat that will ignore him." - Dereke Bruce

More important that post surgery (if you need it) they do something to prevent clots. I don't think it adds appreciable risk on TOP of the surgery - orthopedic surgery is a high risk.....

The IUD has as good or BETTER contraception statistics than tubals, without surgery.....

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cat
Sponsored by Suntheanine, Lycored and Celadrin
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Don't those use hormones? And, since I'm almost 40, does it make sense to use a temporary solution that will come out in a couple years? Tough decision. I know you're not my doc and I don't want to put you on the spot, just curious to get a different perspective.

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Jen

"In order to keep a true perspective on one's importance, everyone should have a dog that worships him and a cat that will ignore him." - Dereke Bruce

copper T has not hormones and lasts 10 years......
even IF you chose the Mirena (progesterone released only in the uterus - no clot risk as that comes from estrogen) it is good for 5 years and when the old one comes out a new one can go in same day.

MUCH less recovery and believe it or not lower pregnancy risk....
I was trained in tubals but don't do them any more....

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cat
Sponsored by Suntheanine, Lycored and Celadrin
http://www.lycored.com/web/content/library.asp http://suntheanine.com/Research.cfm http://celadrin.com/pages/studies.php

Please, can you tell me, is this a risk, however small, just for BC pills, or is there a risk for taking hormones as well (BIH)?

all estrogens.....

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cat
Sponsored by Suntheanine, Lycored and Celadrin
http://www.lycored.com/web/content/library.asp http://suntheanine.com/Research.cfm http://celadrin.com/pages/studies.php

I'm not a doctor, but I've worked really closely with an ob/gyn who specializes in hormonal issues and bioidentical meds on exactly this subject. I hit the peri-menopause hormone mess about two years after my dvt/pe, right when my mother had a major stroke resulting in her moving in with us and requiring nearly full-time care, and as my son was hitting the worst of his adolescent years, leaving me pretty out of control. Major mood swings, depression, etc. I went to a specialist ob/gyn because I felt like I had to do something. The research on bioidentical hormones is still emerging, but there is an ongoing study in Europe (the ESTHER study). The preliminary evidence is that transdermal BIH (cream, patches) do NOT increase clot risk, although it's best to be used with micronized progesterone if you still need progesterone. Here's a link to an article. My doc has also given me copies of a couple of other published studies indicating the same thing.

Thanks Heidi, and Cat.
Heidi, can you try posting the link to that article again?
Did you take the hormones, and they help?

I just realized that the link I included was for Medscape, which requires registration (free). Go to medscape.com and register, then the link is http://www.medscape.com/viewarticle/552778. Here's another article.

Keep in mind, though, that I'm not a doctor and Cat is. I'm just repeating my lengthy conversations with my doctor. This type of stuff is pretty much the focus of my doctor's practice, but you should probably talk with your own doctor. The research on bih is in its infancy and it's impossible to know how things will turn out with more comprehensive studies. Before doing anything with me, my doc was very thorough in evaluating if I had any genetic risk factors or other markers that might raise concerns. Every time I see her (thankfully only twice a year now, but more often originally), we draw a minimum of six vials of blood to check everything out.

And, yes, I'm using Vivelle Dot with micronized progesterone (from a reputable compounding pharmacy) and it helps enormously. My mood is better, I'm sleeping at night, hot flashes are controlled, and the angry things my mother says as a result of her dementia don't usually make me cry.

vivelle dot and micronized prog are my favorite combo to use on women.
Basically going all the way back even to when I was in med school, the lore was that transdermals do not increase clot risk because there is no first pass liver effect. However, then the birth control patch should not increase clot risk and it does....

I know about the european data, it is why I AM a fan of HRT (and have always used BIH unless a patient begs me to do something different).....

I would be VERY wary of using any estrogens with a history of DVT (though HRT is much lower doses than OCs).

Without a history of DVT I would not be so worried....

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cat
Sponsored by Suntheanine, Lycored and Celadrin
http://www.lycored.com/web/content/library.asp http://suntheanine.com/Research.cfm http://celadrin.com/pages/studies.php