Between articles about political misdeeds, murder hornets, and mystery seeds, I came across this headline recently: “How being on the Pill could increase your risk of dying from coronavirus, docs warn.”
The tabloid newspaper’s story—which also included subheadings like “Deadly DVT” and frightening graphics about COVID-19’s spread—seemed to suggest a new study had found an increased risk of blood clots in women on birth control who contract the virus. Its alarmist tone and tidy conclusions (increased risk + increased risk = imminent death) raised red flags.
In it, Dr. Daniel Spratt and Dr. Rachel Buchsbaum note the “troublesome frequency” of blood clots and venous thromboembolic events (VTEs) in patients hospitalized with COVID-19. They then point to volumes of research showing that both pregnancy and medications that contain estrogen—including combined oral contraceptive pills, hormone replacement therapy (HRT) to reduce menopause symptoms, and oral estrogen taken as part of gender affirming care—can also raise a person’s risk of blood clots, VTEs, and stroke.
The authors ask the obvious question: Are people who are pregnant or taking estrogen at a higher risk of getting a blood clot if they get sick with COVID-19? The commentary does not claim to answer this question.
The news stories were wrong to call Spratt and Buchsbaum’s commentary a study. It wasn’t one. There were no patients, no control groups, no observations. In fact, the authors state quite clearly, “no reports of increased incidence of VTEs in pregnant women or women taking estrogen preparations who also have COVID-19 have emerged.” So why publish this at all?
I spoke to Dr. Spratt, who said the purpose of the commentary was to guide clinicians and prompt future research. He said there are some things clinicians can do now to help lower the risk of blood clots such as using anticoagulation drugs recommended for all patients, especially pregnant patients, hospitalized with COVID-19. Spratt said people taking estrogen should make sure to tell their health-care provider about their medication if they test positive for COVID-19 and develop symptoms. By no means, however, does he think everyone should put their pill packets in a drawer until the pandemic passes.
“Certainly we do not want to take our commentary and have everyone going off birth control or HRT,” Spratt said.
The commentary was also meant to direct future research on this issue so that we can learn more about how and why COVID-19 increases risk of blood clots, and perhaps prevent bad outcomes.
I worry, however, that the scary headlines play into a growing narrative of danger and risk that has been undermining the birth control pill for years.
Some of this may inadvertently come from health-care providers and sex educators like me who sing the praises of long-acting reversible contraceptive (LARC) methods such as intrauterine devices (IUDs) and implants. We elevate these methods because they work for three to ten years without the user having to give them a second thought; getting rid of user error means fewer unintended pregnancies. This enthusiasm may be misinterpreted as experts being against birth control pills. We’re not.
The anti-pill movement appears to have some roots in society’s ongoing quest for a form of “wellness” that idealizes an all-natural life free of nitrates, nitrites, dairy, gluten, preservatives, or any other chemical enemy du jour. As someone who lives in a gluten-free house, I know these can be legitimate health and lifestyle choices. But hormonal contraceptives have gotten caught in an extreme version of this rhetoric, and too often the arguments against the pill are based on anecdotal evidence and pseudoscience.
Interestingly, as I was writing this, another headline came across my feed suggesting the pill might protect against COVID-19. A “preprint” study—that’s a scientific manuscript that hasn’t yet undergone peer review—out of King’s College London looked into estrogen’s effect on the disease and found fewer presumptive positive cases of COVID-19 and fewer hospitalizations among premenopausal people taking combined oral contraceptives. When I forwarded the link to Spratt, he said there’s not enough evidence to make any conclusions yet.
“It is possible that being on estrogen or being pregnant may make you less likely to contract COVID-19 but also that being on estrogen or being pregnant may make you more likely to get a blood clot if you do develop COVID-19,” he said.
New findings and theories about COVID-19 will come out daily, and they will contradict each other. It may be years before the science is settled. For now, remember to read past the headlines with a healthy level of skepticism. Access to all methods of contraception is vital, especially during a global pandemic and unprecedented economic downturn when people need to be able to make their own choices about whether and when to have children. As Rewire.News reported, political forces won’t stop trying to get in between people and their birth control. The last thing we need right now are alarmist headlines suggesting contraceptives and COVID-19 are a deadly combo.