How Soon Can I Start Taking the Birth Control Pill After TT?

This is an important question. Birth control pills can increase your risk for clotting especially in the first several months. I would discuss this issue at length with your gynecologist and plastic surgeon for specific recommendations tailored to you and the procedures performed.

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 (and 2 weeks after) 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.

 

Some surgeons have their patients stop birth control pills (BCP) and some do not. The reason to stop them preoperatively is to decrease the risk of forming blood clots referred to as deep venous thrombosis (DVT) which occur more frequently in patients taking BCP. There are no firm guidelines based on scientific data with regard to how long to be off of them before surgery or when to resume BCP after surgery. If you have stopped them, many plastic surgeons would recommend not resuming taking them for 2 weeks after surgery.

Discuss this as well as additional methods to diminish the risk of DVT with your plastic surgeon who should be certified by the American Board of Plastic Surgery and ideally a member of the American Society for Aesthetic Plastic Surgery.

Robert Singer, MD  FACS

La Jolla, California