Is it safe to take Progesterone only pills, before during and after having a Tummy Tuck, Liposuction and Brazilian Butt Lift?

Question

I hv menorrhagia and currently take loestrin fe to control the bleeding . I was advised by my doctor to stop taking my birth control pills 2 weeks prior to my surgery and for at least 6 weeks post surgery. To control the menorrhagia while off of the Birth control I have been prescribed a progesterone only pill. Are there any concerns about blood clots or anything else while having a surgery like this while on progesterone only pills?

Tom J. Pousti, MD · Answer

This topic is somewhat controversial;  there is no “standard” or official recommendations that  can be made here. Although it is thought that the use of estrogens (or the natural higher concentration of estrogen seen during later pregnancy)  may lead to a greater incidence of thromboembolic events (clot formation and lower extremities and/or lungs),  there is no  "standard of practice”.   Some of the studies I have looked at demonstrate a 9 time greater risk of admission to a hospital for treatment of  thromboembolic  events (1:2000) for women who use oral contraceptives, compared to women who  do not use oral contraceptives (1:20,000).  These studies do not involve surgical patients.   Some studies Involving surgical patients report that for those women taking an  estrogen containing oral contraceptive and undergoing elective  major surgery there is a doubling of the risk  of deep venous thrombosis, relative to the general population.

The risk seems to be somewhat dependent on the type of oral contraceptive, and the quantity of estrogen involved. Other risk factors include obesity,  inherited blood clotting disorders,  a previous history of deep venous thrombosis,  cancer patients,  certain auto immune diseases,  inflammatory bowel disease, hypothyroidism, renal disease,  long-distance air travel…

The stopping of oral contraceptives prior to surgery may be of concern to patients/physicians at the risk of pregnancy is high,  due to improper technique or low success rate.  There are papers published recommending the continued use of oral contraceptives for this reason.  These authors recommend careful attention to the use of  venus thromboembolic prophylaxis during the time around surgery.  The alternative strategy  is to switch women to progestin only pills,  as this does not have a high association with thromboembolic events.
On the other hand, there are many authors, based on their studies, who recommend stopping the use of oral contraceptives prior to surgery.  The  recommendations for the length of time, prior to surgery, that these medications should be stopped vary; the optimal time for cessation is not known.  The most common recommendations I have seen is to stop the use of estrogen related containing oral contraceptives 4 weeks prior to surgery.

Ultimately, you will need to check with your own plastic surgeon ( and possibly OB/GYN physician) for their recommendations. As I mentioned above, these recommendations will vary from one practice to another.  In my practice,  given that we know the risk of venous thromboembolic events are cumulative ( and we want to do everything we can to decrease risk),  I recommend stopping oral contraceptive pills four weeks  prior to  major elective surgery  and the use of an alternative method of birth control.  Of course, the use of other measures such as early ambulation and the use of  pneumatic compression stockings are routine.

I hope this helps.

Brian K. Brzowski, MD, FACS · Answer

Bottom line is:  ask your surgeon.There is some controversy based on a review of the literature about the amount of risk reduction for blood clot formation when using Progestin only pills.  This seems to be primarily dependent on the dosages. Here's one opinion from Duke University:  "While progestin in the higher doses used to treat abnormal vaginal bleeding has been shown to INCREASE the risk of thrombosis five- to six-fold, progestin in the doses used in contraceptives has NOT been shown to increase the risk of deep vein thrombosis or pulmonary embolism."This is a conversation you should have with your surgeon and follow his or her advice.Best of luck.

Is it safe to take Progesterone only pills, before during and after having a Tummy Tuck, Liposuction and Brazilian Butt Lift?

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Is it safe to take Progesterone only pills, before during and after having a Tummy Tuck, Liposuction and Brazilian Butt Lift?

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