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How to deal with the risk (small but lethal) to develop thrombosis due to tablets



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RIO – More and more often, to find a young woman who left the tablet back. Created in 1960, the tablet, which was a revolution in the life of this segment of the population – who first had the chance to make family planning & # 39; and – today regarded with caution by women. The main fear of thrombosis, ie the formation of a blood clot in the blood vessels or the heart. In some cases, the condition may progress to more serious & # 39; oznyh complications embolism. This side effect pills, and described in the medical literature, a very rare, but if it occurs, has the potential to be lethal.

Contraceptive Guide:
Knowing the advantages and disadvantages of each method

Risk women who take birth control pills develop thrombosis 4 of 10 000 during the year. If she takes pills, the risk more than doubled, becoming 10 in every 10,000 a year, explains gynecologist Ilza Maria Urbano Monteiro, the Brazilian Federation of Gynecology and Obstetrics (Febrasgo).

This risk was significantly reduced in recent decades. The first tablets had one dose of hormones to 90% higher than today, causing more serious & # 39; serious side effects in 60 So why the wave of rejection of tablets come only in recent years?

– Today, you can choose from. If the tablet has been created, there were no other options, such as the IUD or diaphragm – is responsible Ilza, which is a & # 39 is the vice-president of the National Committee of contraception Febrasgo. – With the growth of women's capacity, women began to pay more attention to the choice of how to care for the body, to know how it works, what the range of options they have and be able to decide with your doctor, that & # 39 is safer for everyone's business.

For extraction Garden Carolina (read the full report in the & # 39; the volume at the end of the report), which had pulmonary embolism, thrombosis, in less than a month – and had no other risk factors in the annex to the contraceptive pill – red alert light up. She complains about the lack of medical staff.

– As always, I was healthy, I never imagined that this could happen to me, – she says. – All my life, not a gynecologist, with whom I have consulted with me told me, warned about the risks.

If this has happened to Ana Carolina Ashe (full report & # 39; volume as at the end of the text), which was thrombosis in 2015 and now has a sequel thickening of the veins in the leg.

– The truth is that I was very lucky. I could die. I got the feeling that the tablet with & # 39 is a Russian roulette: it's okay … as long as there is, – she says. – What's the most scared me was the fact that the drugs made me sick. And when I started to complain of thrombosis, the doctor said that I was "a very impressive little girl." I'm still suffering on misogyny.

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Manual for physicians themselves

Gynecologist Ilza Maria Urbano Monteiro noted that in order to better guide the doctors themselves and the general public, Febrasgo launched a campaign
#VamosDecidirJuntos,
a web page that collects information on all existing methods of contraception.

– The fact that we can not do is to demonize the pills because, for all the people who take the risk is very small. During pregnancy, for example, the risk of thrombosis is three times higher than when using the tablets. But it is important that women are well informed to choose it, under the guidance of a doctor, a risk worth running – highlights.

Adriana Scavuzzi, member of the Technical Chamber of obstetrics and gynecology of the Federal Council of Medicine (CFM), explains that always requires careful consultation to select the most suitable form of contraception for every woman – and this should be done with the share. And not with a hastily written prescription for a few minutes.

– You can not assign contraception to a woman in five minutes, – says the doctor.

This is because there are some contraindications, and the physician should evaluate. The tablets may be taken, for example, for women who have already had some thrombosis, with a history of stroke or cardiovascular disease in the family & # 39; and among first-degree relatives, smokers aged 35 years or older, obese or hypertensive.

Not every pill increases the risk of thrombosis

the risk of thrombosis associated with estrogen. It is primarily responsible for the increase in clotting factors and, therefore, the higher the dose of the hormone, the greater the risk of developing the disease. Thus, only the combination of estrogen and progesterone pills have some possibility of causing thrombosis.

There is a second set of tablets, only with progesterone. They do not offer this risk. Following this tablet, however, is low because about 30% of women have minor bleeding. The trend is that, with the use, they reduce, but many of the screenings of the method in the early stages because of the concern.

– Tablets progesterone has very good efficacy similar combinations. But as a rule, not the first choice for women because it can can generate these "menstrual leak", and in some cases may also interfere with libido – says Rosa Isabel Enriquez Gynecologist Clisam team and the hospital of Santa Lucia.

Among the non-hormonal contraceptive methods – which means that they do not interfere with any way to hormones and, therefore, far from causing thrombosis – a copper IUD, diaphragm and a condom. In general, many women who have to rethink the tablets refer to them.

IUD is underutilized

About 30% of women aged 20 to 39 years in Brazil, using birth control pills, according to the Febrasgo. But the IUD is used by less than 5% in the same age group. For experts, this method is used insufficiently.

– The effectiveness of (to prevent unwanted pregnancies), the Navy is much better (the tablets). The annex to the elimination of the risk of thrombosis – says Ilze gynecologist.

She explains that each tablet can not cause unplanned pregnancies and three per thousand women throughout the year. But in practice, the statistics show that 80 out of every thousand women become pregnant within a year, even on tablets. This is because he & # 39; is common, that they forget to take a day or delay the schedule. On the other hand, the risk of failure ISDA three cases per thousand, both in theory and in practice – because the device is in the body for many years, rather than depending on the correct use of the patient.

– So I say that the main problem of the tablet is not an insult, but Sun – says Ilze.

Gynecological Adriana Scavuzzi, CFM, IUD use should be encouraged, including among teenagers – they have already begun their sexual life. She believes that there is a lack of information about contraception in general.

– If a woman migrates from tablets to the ISD, for example, is very good. Since this is a safety device. My fear of those who oppose the pill because of the fear of thrombosis, and starts not to use personal or apply methods without scientific evidence, using skates. There is a reckless and is not justified, – he says.

Genetic tests are not displayed

Many women have the following question: if there are medical tests to see if the patient has any genetic mutations that cause thrombophilia – a tendency to develop thrombosis – should not be necessary for gynecologists asked this exam before prescribing pills?

Experts do not have a reaction. They say that it is unrealistic to request genetic testing of all women who are seeking contraception. There is a kind of test in the Unified Health System (SUS), Edward covered by insurance and is expensive. Moreover, even if the test is negative, there is no guarantee that women will not develop thrombosis.

– There are people who have no obvious risk factors and genetic testing does not show anything. Still, a person develops the disease. It may be that women have some kind of mutation that medicine has not yet set and could not be traced, – says gynecologist Karina Tafner, specialist in gynecological endocrinology and human reproduction from the Santa Casa de Misericordia de Sao Paulo .

"Drug Sexuality"

According to experts, women's relationship with the birth control pill have been changing over time, depending on the overall social needs of each time.

The first impulse for the study, which would result in the early 1960s, the birth control pill has been made by scientists, but feminists. This explains one of public health research expert Marin Nucci in 2012 at the Institute of Social Medicine (IMS / UERJ).

"Margaret Sanger, an activist of women's rights and the pioneer of birth control in the United States, was looking for a long time, scientists were able to develop a simple and inexpensive method of contraception until then, until you find the biologist Gregory Pincus in 1951 another woman perform a central role in the creation of pills Katherine Dexter McCornick, Sanger each, which funded almost entirely from its own resources research project, "says Marin, in your text.

In the study, the author discusses the idea of ​​a "day of drug per day" and "medicalization of sexuality" – and it is against the idea that many women today are raised. Since its inception, the pill was not meant to treat a disease, but rather to use regularly for healthy women.

"But the fruit of feminist claims, the life of the tablet revolution is not only women, but also society as a whole. Nevertheless, it is a drug and like any drug, is a danger to the health of their users, "she continues.

She is, among other things, as a biologist Gregory Pincus has established "normal" will be a 28-day cycle; and menstruation – although biologically unnecessary – should emulate when using pills with an interval of one week, so that the product is better received.

Reports: "I had a thrombosis"

Read below for the two first-person accounts of women, even healthy, and groups with a predisposition to thrombosis – not hypertensive or smoking, for example – have had problems. The only risk factor was a combined pill (estrogen and progesterone).

In both cases, thrombosis has evolved to pulmonary embolism, catastrophic complications.

Carolina Garden, 33, journalist

Carolina has been the central and peripheral pulmonary embolism in less than a month:
Carolina has been the central and peripheral pulmonary embolism in less than a month, "the lack of information and guidance could be worth my life" Photo: personal archive

The evening of April 4 this year, I was home alone and started to feel a lot of pain to breathe. Whenever air pulled, felt strong pressure in the upper abdomen. My body collapsed, drenched in cold, and I began to see all black. It was the first time I really thought I might die.

At that moment, my husband called me and said that he was looking for me in a hurry to take me immediately to the hospital. He just took my CT made the day before, and the exam showed a spot on his lungs, which indicates the possibility of pulmonary infarction.

I had the central and peripheral pulmonary embolism in the right pulmonary artery obstruction. interruption of blood flow leading to heart attack lung segment. I was hospitalized for seven days of treatment with John & # 39; ektsyynym anticoagulant, and now must maintain oral anticoagulation for up to six months.

"The moment I heard that the chief suspect in my pulmonary embolism fell pills, I was seized by a mixture of feelings: sadness, fear, anger and even guilt for not having made a step forward."

Carolina Garden

their diagnosis of thrombosis

After all, this is not any other obvious risk factors, the prime suspect with & # 39 is the use of birth control pills. All the doctors who treated me in the hospital reported that recently accompanied or knew of similar cases of other women my age.

I am 33 years old and takes a pill with 17 some time now began to question the use of the tablet and its impact on a woman's body and felt uncomfortable with the idea of ​​taking hormones pump. I also read about the cases of women who have had thrombosis, pulmonary embolism and other diseases due to the use of hormonal contraception.

All of this made me think to replace pills for the Navy, but did not take the idea forward. As always, I was healthy, I never imagined that this could happen to me. One of the biggest mistakes a person – and mine too – always think that it will never happen to them.

All his life, not a gynecologist, with whom I have consulted with me said to me, avoided the risks.

At that moment I realized that the chief suspect in my pulmonary embolism fell pills, I was seized by a mixture of feelings: sadness, fear, anger and even guilt over not taken a step back. I thought about the many ignorant women who can still go through what I went through.

The lack of information and guidance could have cost me my life. With fast service and support network of people who have been by my side all the time, I was able to recover well and without complications. This is my case with a & # 39 is an example for the preservation of life and health of other women.

Ana Carolina Ash, 34, designer

Ana Carolina thrombosis in 2015, at the age of 29 years:
Ana Carolina thrombosis in 2015, age 29: "My leg was warmer and more swollen than usual, red and pasty texture – like wet sand" Photo: personal archive

I took the combined pill since 14 years, even before starting their sexual life. I heard from my medical advertising ever: to help with pimples, with cramps, regulates the cycle. My gynecologist has never asked if I had a family history of thrombosis. Fortunately, I did not. It was not in any risk group, we have always had a stable weight, never smoked, to maintain an active lifestyle. And I never felt like a side effect due to the tablet, such as headaches, mood swings, malaise, nothing. My flow was light, I have not had colic, and never asked me when the tablet can hurt me.

Then, in September 2015, when I was 29, I made a superficial surgery to treat mild varicose veins. After any step, there is a risk of thrombosis, because blood clot develops as a part of wound healing. This is normal. But a stroke only happens if you have any risk factors such as smoking, obesity, genetic predisposition. Then, if you do not take precautions, clots can collect and form clots. I followed the doctor's instructions in order to prevent the formation of thrombosis in healthy people: moving normally, would not let his feet alone. That should be enough. Every day after the surgery, I should be better, with fewer legs. But I just got worse. I asked angiologist physician, who was with me, but he just said that I was too close to the heart, and should be some kind of pain in the muscles. He said that I was "very impressive girl." In addition, I suffered misogyny.

At the same time, my leg was warmer and more swollen than usual, red and pasty texture – like wet sand. I clicked, and the skin does not return to the site immediately. then I searched for an orthopedist, since my angiologist claimed that the cause of my pain was muscular problem. As this new doctor, he ruled out any muscle causes, referred me to the Pro-Cardiac Hospital, and, there, it took only ECCO doppler, a simple test as ultrasound for the diagnosis of thrombosis. I was with the popliteal vein, a large vein behind the knee, completely blocked. The test results are not speaking, not a stream. I was immediately hospitalized.

"I had a feeling that the tablet with & # 39 is a Russian roulette: it's okay … as long as no. I have to do genetic testing to see if I have a genetic predisposition. But it was negative. What scared me that the drug made me sick. "

Ana Carolina Ash

it thrombosis

The treatment was simple: anticoagulants John & # 39; ektsyi body go, slowly unbuttoning thrombus. The danger was he moving stop and go to some other vital area of ​​my body, which is called embolism. And that's exactly what happened shortly afterwards: I had a mild shortness of breath tests and discovered a pulmonary embolism. Every time my heart was pounding, he pushed my legs clots in the lungs. Every time my heart was pounding, I was close to death. I was very frightened by the fragility of life, as in the second everything can change.

I had to undergo surgery to place a filter in my vena cava to keep clots before they reach the lungs. Keep the filter in a small pot on my shelf to remember. In total, nearly a month in the hospital: a week in the intensive care unit (TA) after surgery, followed by semi-intensive, and finally went into the room. I could not get up or go to the bathroom or take a shower, but felt no pain and was happy to be alive. May the prospect of change. Пасля гэтага я павінен быў узяць разрэджвання крыві на працягу года, і зараз у мяне ёсць толькі пабочны эфект, як патаўшчэнне сценак правай нагі вены. Мне трэба рабіць рэгулярныя фізічныя практыкаванні, каб дапамагчы назе брыняць і няма на гарачыя дні выкарыстоўваюць компрессіонные панчохі. Мне проста трэба прымаць прэпараты для разрэджвання крыві, калі злавіў самалёт, і не дазваляйце чарты ногі ўніз на працягу больш за чатыры гадзіны. Акрамя таго, я вяду нармальнае жыццё, я вярнуўся, каб танцаваць і рабіць усё, што мне падабаецца.

Ісціна заключаецца ў тым, што мне вельмі пашанцавала. У мяне ўзнікла адчуванне, што таблеткі з'яўляецца руская рулетка: гэта нармальна … да таго часу, пакуль няма. Я павінен зрабіць генетычнае тэставанне, каб убачыць, калі я што-небудзь тромбофилии, атрымаў у спадчыну схільнасць да развіцця трамбозаў. Вынік быў адмоўным. Што мяне напалохаў, што наркотык зрабіў мяне хворым. Таблеткі сталі дрэнна здаровым целам. Кожнае лекі мае пабочныя эфекты, але гэтыя эфекты ў выпадку таблетках з'яўляюцца вельмі сур'ёзнымі і непрадказальнымі, так што нашмат менш мужчынскі таблетка не была зацверджана. Гэта не магчыма, рэкамендуецца, як самы бяспечны спосаб для нас, каб прадухіліць непажаданую цяжарнасць. Гінеколаг, які заўсёды суправаджаў мяне прыйшоў наведаць мяне ў аддзяленні інтэнсіўнай тэрапіі, і я сказаў, што мы маглі б паспрабаваць «менш тромботический» метад. Я не хачу, каб некага «менш трамбоз» ў наступны раз!

Я змяніў свой гінеколаг, і я пачаў выкарыстоўваць медныя ВМС, не звязвайцеся з нашымі гармонамі. У пачатку ў мяне было больш спазмаў, больш вугроў … але сёння я прачытаў гэта вельмі добра. Я даведаўся больш аб маім цыкле і выкарыстоўваць яго ў сваю карысць, скарыстаўшыся дадатковай магутнасці фалікулярных фазы (да авуляцыі) або збіраць мяне і спыняючыся, каб пачуць мяне ў лютеиновой фазе (да менструацыі, страшны PMS). Менструальны цыкл не павінен быць адноўлены, рэпрэсаваны, кантраляваным штучна. Варыяцыі гэтага можа дапамагчы нам зразумець, што адбываецца з намі і ў нашым жыцці, кожны крок ён мае нешта, каб навучыць нас. Стаўленне некаторых лекараў да мінімуму, што жанчыны адчуваюць сябе больш чым жанчынаненавіснікі стаўленне забойцы стаўленне.

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