oral contraceptives & heart valve

[florenze]

Hello,

I have a mechanical heart valve (mitral) and I used to be on Yasmine (oral contraceptive) before I had the heart valve replacement. However, my doctor took me off the Yasmine b/c there is danger of a stroke or blood clot with oral contraceptives. However, my periods tend to be very heavy and last a long time plus I'm having trouble with acne now. I take coumadin daily b/c I have a mechanical heart valve. Is there anyone who has a mechanical heart valve who is or has taken oral contraceptives? Did you have any problems while taking the oral contraceptive? Does anyone know if the risk is small or great for getting a blood clot or having a stroke while taking oral contraceptives? Thanks.

 

[geebee]

Welcome to VR.com.

I have no personal experience with a mechanical valve and BC pills because my doctor took me off the pill when I was first diagnosed with valve problems and then I had my tubes tied and then a hysterectomy so......

However, I would think coumadin would help prevent any clotting that might happen with BC pills unless the clotting comes from something that coumadin doesn't work on.

Ross, maybe this should be switched to the anti-coagulation forum so Al will see it.

 

[twinmaker]

Yes, I've had experience taking OC and I have a mechanical mitral valve. For years after my valve was implanted, my GYNs would never put me on them. But as I got older (in my mid to late 40's), my periods were getting heavier and heavier. We had moved to Atlanta, and my GYN was with Emory University and was very progressive thinking at least compared to my other GYNs. She ran it past my cardiologist (also with Emory) and they agreed I could take a low dose pill and have my blood pressure monitored regularly. I was put on Loestrin and was on it for five years. In fact, I took it continuously (per my doc's orders) and didn't have a period for five years. It was heaven! I had no problems whatsoever. I came off the pill to see if I was going into menopause and I was beginning that so never went back on the pill. If I can give you any other info, just let me know. Oh, I'm sure the docs were assured the Coumadin would protect against blood clots. LINDA

 

[tobagotwo]

There is a percentage of women on the site who are on Coumadin who have indicated a similar issue with longer and heavier periods. There are threads about it that you can search for on the site.

There isn't a lot of medical literature support for it, but from the nature of number of the postings on this site, my belief is that it's a real issue, and that it's frequently downplayed or ignored by (especially male) doctors as being a false perception on the woman's part or "just an inconvenience," and vastly underreported.

A Google of "Coumadin menstrual" pulls up 136,000 entries, and they seem to be supportive of the notion that warfarin does affect the periods of at least some women. Some of them do refer to the prescribing of birth control or other hormonal pills for this. The main issue seems to be watching for high blood pressure that can be an side effect of the hormones. However, although HBP increases stroke potential, warfarin decreases it.

Best wishes,

 

[florenze]

oral contraceptives & heart valve

Thanks for the information, Bob. I will look up the info. on Google.

Francesca

 

[Gnusgal]

When I got my mechanical valve the docs switched me from my low dose estrogen pill to a progestrone only pill, because of the risk of clots. However, less than a year later I had an ovarian cyst that burst, causing MAJOR internal bleeding, emergency surgery, and a transfusion of 4 units of blood. So I was put back on an estrogen based pill. Apparently the fact that the progestrone only pills allow you to ovulate was the problem. But they don't have the same risks for clot. However, prior to putting me back onto the estrogen pill the GYN checked with a hematologist who said that the coumadin should prevent any potential clots from the BCP. This was five years ago and I've been on loestrin ever since without incident.

 

[Guest]

There is a feeling among the anticoagulation community that Yasmine should be taken off the market. It is what is called a "third generation" oral contraceptive. While the actual mg dose of estrogen is low, it is a very potent estrogen imitator. It has a HUGE risk of causing blood clots.

Whether or not warfarin will protect from clots is entirely unknown. Who would volunteer to see if they got one? Therefore, it is impossible to assure that you won't get one.

It all boils down to how much and what kind of risk are you willing to take. Getting pregnant with warfarin is a risk, getting pregnant with a mechanical valve involves some risk, taking OC without warfarin or mechanical valve involves some risk. There is no right answer, even any proven answer, each person has to say, "Here is what I would least like to have happen" and go from there. You can change your decision as you age and as more information becomes available. However, you always have to say, "I made the best decision that I could based on what I knew at that time".

 

[twinmaker]

I agree with what Al said here. I know for me, it wasn't an easy, quick decision that I made to go on OC. I hadn't been on them since I was first married and before we knew I had a heart problem. But perimenopause set in, I had gotten to the point where I could hardly leave the house the first 2-3 days of my period and then I was having periods that were lasting more than 2 weeks and I'd have a week off and then another would come. I was actually anemic. After putting up with this for a couple of YEARS, I decided it was time to do something. Both my cardio and GYN were supportive of this decision in my situation. It was a good decision for me, but I realize that each person and situation is different. It could have turned out to be the wrong decision. That was the risk I took. I guess I look back on the last almost 34 years since my valve problem was diagnosed, and I've had to make all sorts of decisions with all sorts of risks attached. I've tried to look at the total picture and all the variables involved (including my family) and research and learn as much as I can. I pray a lot and then make a decision. LINDA

 

[Guest]

We all face all sorts of decisions that involve risks every day. It is just that when you say "heart" it puts the risk in clear focus.

 

[florenze]

now on oral contraceptive

now on oral contraceptive

My primary care doctor spoke to my cardiologist about going back on the pill since my periods have become so heavy. The cardiologist gave the ok to take the pill again which surprises me since he did not want me on it last Fall. My gyn gave me prescription for Loestrin 24FE since my cardiologist ok'd it but she was not too keen on the idea. She wants me to get an ablation done which is surgical removal of the lining of the uterus. I told her I might have the surgery done in the summer when I'm off work but I want to try the pill for now. However, I'm VERY SCARED of blood clots or stroke while on the pill and today was my first day taking it. I have my own machine to monitor my INR so I'm going to test it tomorrow. Anyways, I just wondering about those of you who said you took the pill without any problem if you ever considered getting an ablation? Why or why not? Thanks for all your help!

 

[Guest]

As long your INR stays above 2.0 you should run very little risk of clotting. However, keep in mind that the oral contraceptives will not affect the INR.

 

[LUVMyBirman]

Have been going around in circles with my "issues" for years here. Just had another consult yesterday. I was told that ablation was not a cure or a fix. It's a temporary solution. It is successful with some....others return immediatley complaining of original symptoms. Another option was partial hyst. After sleeping on it.......does not appeal to me at the moment.

Based on some of the above posts....really see some potential promise in taking Loestrin. Any further info or thoughts on Loestrin? Al? Since it does not effect the INR. Anyone notice a decrease or change is INR when first starting the Loestrin?

TY

 

[Guest]

None of the oral contraceptives affects the INR.

I think that the warfarin will protect you from clotting if you do take an oral contraceptive.

 

[LUVMyBirman]

TY Al. I really need to do something. Will discuss the option with my card!

 

[Gnusgal]

The way it was explained to me by a gyn who got this info from a hematologist is that the coumadin should prevent clots from the BCP. Don't know if that's true, but I've been on BCP for 4 of the 4.6 years I've been on coumadin and it sure beats the cyst I got when I wasn't on it. I think it's really a matter of "the lessor of evils" in some cases. But this is only my experience. Others may have another stance.

Oh! And I had a gyn recommend to me a uterine ablation as well. Fortunately, he gave me some literature about the procedure and *I* noticed the warning that women with pacemakers should not have the procedure, due to the magnetic field generated by the electronic laser. I didn't ever go back to that gyn, since he obviously didn't take my personal history into consideration when he made the suggestion. If it weren't for that, though, I probably would have jumped at the chance to do the ablation. However, it wouldn't have mattered anyway, I still would have had to be on the BCP to prevent the cysts from coming back! It was just a "no win" situation all around.

Good luck to you and your decision!

 

[LUVMyBirman]

Thanks Niki! I plan to write you tomorrow so we can continue our "chat'

 

[Guest]

One of my students just wrote a page about this. While it does not directly answer the question, it will give you some ideas about which pills are least likely to cause clots.

I would definitely avoid the patch and Yasmin. I see a lot of clots from these (they were not on warfarin).

http://warfarinfo.com/oralcontraceptives.htm

 

[florenze]

OC study

OC study

Thank you, Al for posting this study. It is very helpful in knowing which oral contraceptives are safer to use. My question is that the study gives the approximate risk of having a stroke but in the conclusion it states that patients with atrial fibrillation or mechanical heart valve are at risk for a stroke but it does not give the approximate risk for having a stroke. Does that mean those patients are more at risk for a stroke or can we go by the estimates given for other groups?

 

[Guest]

No body knows. Probably best to try the lower risk agents first.

 

[florenze]

oral contraceptives and heart valve

oral contraceptives and heart valve

I started taking Loestrin 24 FE last Tues. (2/20) and here's what my INR did for the week:
2/19 2.9
2/21 2.7
2/23 3.6

My INR should be between 2.0-2.8. So the nurse has decreased my Coumadin dosage from 6mgs to 4mgs for 2/23, 2/24, & 2/25. I am supposed to retest on Monday and the nurse will change my dosage again if needed. I've changed nothing else other than taking the Loestrin. I will keep you updated...