Substance use disorder: contraceptive options counseling

What’s New in Contraception?

Contraceptive Technology Conference!

Biologic sexism of STIs

Excess breast cancer deaths after COVID-19

Contraception for patients with medical conditions

Pelvic Floor Dysfunction

Treating vulvodynia

Puzzling Over the Hurt Down-Under

Serious Mental Illness and Contraception

New 13-Cycle Vaginal Contraceptive System

The Future of Family Planning in Post-COVID America

New ASCCP Guidelines: Implications for FP

On the alert: mood disorders during 2020 stressors

Sex in the Time of COVID-19

Challenges old and new during the pandemic

Reproductive health in the time of Covid-19

Talking about toys

Missed Pills: The Problem That Hasn’t Gone Away

Find the “yes! . . . and” rather than “no” or “but”

Digital Family Planning: the Future is Now

Irregular Bleeding Due to Contraceptives

When she’s low on libido…

Ouch! Best approaches to menstrual pain

Contraceptive efficacy: understanding how user and method characteristics play their part

Strategizing treatment for chronic heavy menstrual bleeding


Untangling the literature on obesity and contraception

High tech apps for no-tech FABM

Menstrual exacerbation of other medical conditions

From Princeton University: Thomas James Trussell (1949-2018)

The Short and Long of IUD Use Duration

Selecting a Method When Guidance Isn’t Clear-cut

Healthcare in the Time of Digital Expansion

The Scoop on Two New FDA-Approved Contraceptive Methods

Pregnancy of unknown location—meeting the challenge

Big “yes” (with caveats) to CHCs during perimenopause

The role of IUDs (LNG IUDs, too!) in emergency contraception

Combined pills’ effect on mood disorders

Abortion in the U.S.: safe, declining, and under threat

Hope for ovarian cancer screening test

Breast cancer still a small risk with some hormonal contraceptives

New treatment modality for BV

Record rate of HPV-related throat cancer

Viruses in semen potentially transmissible

Don’t Abstain from Your Role in Abstinence

Teens births declining but geographic ‘hotspots’ defy trend

Online Medical Abortion Service Effective and Safe

Do Women Really Need to Wait That Long?

Reassuring news on depression and OC use

PMDD: Genetic clues may lead to improved treatment

Breast cancer risk when there is a family history

Body weight link to breast and endometrial cancers (and 11 others)

Family Planning in 2017 and Beyond

Make Me Cry: Depression Link (Again)?

Managing implant users’ bleeding and spotting

Zika: Updated guidance for providers

Pharmacist-prescribed contraceptives

Hot off the press! 2016 MEC and SPR

Zika virus fears prompt increased request for abortion in nations outlawing abortions

Opioid use epidemic among reproductive-age women

Good news on the family planning home front!

War Against Planned Parenthood Hurts Women

Win-win for both treatment and prevention

Center of the Storm


Menopause, mood, mental acuity, and hormone therapy

Emergency contraception for teens

Postpartum Contraception: Now, Not Later

Reproductive tract infections, sexually transmitted infections, or sexually transmitted diseases: “a rose by any other name…”

Are we practicing what we preach?

Be alert to VTE in hormonal contraceptive users

LARC among teens increased 15-fold, but not enough

Brain cancer and hormonal contraception

Free tools: Easy access to the US Medical Eligibility Criteria for Contraceptive Use

Alcohol consumption when pregnancy is unwanted or unintended

Latest Data on Contraceptive Use in the United States

LateBreaker sampler from Contraceptive Technology conference

Emergency Contraceptive Pill Efficacy and BMI/Body Weight

Handout on Unintended Pregnancy and Contraceptive Choice

Ask About Withdrawal (Really!)

Rules to Practice By: Safety First and Cleanliness is Close to. . .

What’s Vanity Fair Got Against the NuvaRing?

Promising New Treatment for Hepatitis C

Numbers matter, so make them simple for patients

The Recession’s Effect on Unintended Pregnancies

Lessons Learned from the Contraceptive CHOICE Project: The Hull LARC Initiative

Applying the “New” Cervical Cytology Guidelines in Your Practice

Acute Excessive Uterine Bleeding: New Management Strategies

Medical indications for IUD use in teens

Whatever happened to PID?

Update on Emergency Contraception New and Improved

Be alert to VTE in hormonal contraceptive users
June 2015


Venous thromboembolism (VTE) is a rare complication with hormonal contraceptives. However, the risk is not zero. And unfortunately, the condition may be overlooked when it occurs in an otherwise healthy young woman. When overlooked, VTE can become dangerous.

Clinicians know that the risk for VTE is greatest among women not using hormonal contraceptives: those who are postpartum (511 per 100,000 women-years) or pregnant (98.5 per 100,000 women-years). Clearly, use of hormonal contraception, in reducing the risk of pregnancy, reduces the risk for VTE. This is an argument in favor of the safety of the methods. Yet it is important to remember that hormonal methods do increase a user’s risk for VTE, about 2- to 3-fold.

Figure 1: Rates of VTE

Blood clot risk


The greatest risk for VTE occurs in the first 3 months to a year after a women begins using hormonal contraceptives. That applies to new users as well as users who have taken a break and are restarting the method. Risk factors include age, weight, tobacco use, and clotting disorders. Combined pill users with a BMI great than 30 have 3 times higher risk. Combined pill users who smoke cigarettes have nearly 9 times higher risk. Users with genetic clotting mutations such as factor V Leiden or prothrombin gene mutation can have anywhere from 6 to 100 times the risk. These clotting disorders are rare, so routine screening is not the standard of practice.

Being alert to the signs and symptoms of thrombotic diseases attributable to hormonal use is important. Suspect pulmonary embolism when a new (or restarting) user keeps coughing, complains of chest pain and shortness of breath. Myocardial infarction also presents with chest pain—crushing, shortness of breath and weakness, or left arm and shoulder pain. Stroke presents with symptoms such as headache, weakness of numbness, visual problems, or sudden changes in cognitive ability. Headache may also accompany retinal vein thrombosis, along with complete or partial loss of vision. Thrombophlebitis presents with leg swelling, heat or redness, pain and/or tenderness.  Thombosis of the mesenteric vein or the pelvic vein produces abdominal pain and, depending on location, vomiting or cramps.

Ever important is patient education. Clinicians would be well advised to tell new hormonal contraceptive users, or those restarting after a ‘break,’ about the red flags of VTE, often taught by using the mnemonic ACHES:

        • Abdominal pain
        • Chest pain
        • Headaches
        • Eye problems
        • Severe leg pain

Please feel free to download and print this handout: ACHES figure