Timing Your Hormonal Birth Control Before Surgery: Essential Considerations

Deciding when to cease hormonal birth control prior to surgery is influenced by several factors. These include the type of contraceptive you use, your predisposition to blood clots, and the nature of the surgical procedure.

Combined hormonal contraceptives have been linked to a heightened risk of blood clots, which is further exacerbated by surgical interventions. To mitigate potential complications, your surgeon may recommend either pausing your contraceptive method or switching to a safer alternative.

When Should You Pause Your Hormonal Contraceptive?

If you have a significant risk for developing blood clots or are facing a high-risk surgical procedure, it is advisable to discontinue hormonal birth control about 4 weeks prior to the surgery, according to Dr. Maria Sophocles, an OB-GYN and medical director at Women’s Healthcare of Princeton in New Jersey. Conversely, if your clotting risk is low and the surgery is considered low-risk, a cessation of just 1 week may suffice. It is crucial to remember that blood clots are comparatively rare; estimates suggest that 1 to 5 in every 10,000 individuals assigned female at birth (AFAB) who are not using hormones or pregnant develop blood clots annually. For those using combined hormonal contraceptives, the incidence rises slightly to 3 to 9 per 10,000 AFAB individuals each year.

Hormonal Methods Speficially Impacted by Surgery

Combined hormonal contraceptives consist of synthetic estrogen and progesterone. While estrogen alone does not directly cause blood clots, it can marginally elevate risk, particularly for deep vein thrombosis (DVT) and pulmonary embolism (PE). The following contraceptive methods contain estrogen:

• Combination pills (including both continuous use and extended cycle)
• Transdermal patch
• Vaginal ring

Among these, combination pills are the most frequently prescribed form of contraception in the United States. According to Dr. Sophocles, “Oral contraceptives are statistically significant contributors to blood clot occurrences.” On the other hand, progesterone-only methods do not carry the same clot risk, as noted by Dr. Renita White, OB-GYN from Georgia Obstetrics and Gynecology in Atlanta and Alpharetta.

However, all hormonal methods may be vulnerable to disruptions in efficacy due to the medication Sugammadex (Bridion), often used to reverse sedation effects post-surgery. This disruption can mimic a missed dose of contraceptive pills. The precise equivalent for other hormonal devices remains less certain:

• Implant
• Intrauterine device (IUD)
• Injectable contraceptives
• Transdermal patch
• Vaginal rings

Sugammadex remains in your system for about 7 days, thus potentially affecting the prevention of pregnancy for that duration.

Identifying High-Risk Surgical Procedures

The majority of surgical interventions carry an elevated risk of blood clots, particularly those exceeding 45 minutes in duration, necessitating prolonged bedrest during recovery, or surgeries involving bones. Factors that can elevate your personal risk include:

• Age
• Medical history
• Family health background
• Pre-existing health conditions
• Fitness level
• Tobacco use

Common surgical procedures classified as very high risk include:

• Vascular surgeries, particularly those involving the aorta
• Heart surgery
• Chest surgery accompanied by lung removal
• Transplants of heart, lung, and liver

Meanwhile, the following generally fall under high-risk categories:

• Colon or rectal surgery entailing bowel removal
• Kidney transplantation
• Joint replacements (shoulder, knee, hip)
• Open radical prostatectomy
• Cystectomy (bladder removal)
• Cancer surgeries, notably in the head and neck region

Typically, lower-risk surgeries are outpatient procedures where you can leave the same day, while higher-risk surgeries necessitate an inpatient stay.

Alternative Contraceptive Options

To prevent unintended pregnancies during this period, consider utilizing a non-hormonal back-up method. Effective options include:

• Cervical cap
• Condoms
• Diaphragm
• Spermicides
• Sponge
• Vaginal films
• Vaginal gels

If you are undergoing sedation, continue using a back-up method for the subsequent week. Alternatively, if sedation is not involved but you still have concerns about clot risks, discuss the possibility of transitioning to a progesterone-only method with your healthcare provider.

Consequences of Surgery While Using Hormonal Birth Control

In most cases, undergoing a short surgical procedure while on hormonal birth control will not pose significant risks, provided you maintain good health and do not have additional clot risk factors. Speaking candidly with your healthcare provider about your medical history—including smoking habits and contraceptive use—is essential for determining your individual risks.

In instances where individuals choose to remain on hormonal birth control, surgeons may suggest chemoprophylaxis, which involves taking medications to lower the chances of clot formation, typically by administering anticoagulants like heparin.

Conclusion: Navigating Hormonal Birth Control and Surgical Procedures

Using hormonal birth control in combination with surgery has the potential to heighten the risk of blood clots. As to whether this risk necessitates a change in your contraceptive approach hinges on your overall health, the specifics of your surgery, among other factors. For personalized guidance on managing hormonal birth control before surgery, it is crucial to consult your healthcare provider.