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April 2021

Contraception, COVID-19 and clotting risk

Women using combined hormonal contraception who are worried about the possible risk of blood clots associated with COVID-19 vaccine may want to consider switching to another contraceptive method, the FSRH says.

However, women should not stop using CHC without talking to a healthcare professional about an alternative, the Faculty adds.

Reports of the possible increased risk of blood clots in people receiving the AstraZeneca vaccine have heightened concerns of users of CHC – the pill, skin patch or vaginal ring – who know that these methods can also increase the risk of blood clots.

In a statement, the FSRH says:

  • Individuals using CHC are at a small increased risk of having a blood clot, but the numbers of clots that happen because people are using CHC is very small.
  • Severe COVID-19 infection increases risk of blood clots. It is possible that milder COVID-19 illness might too. Unless they are severely ill in hospital, individuals with COVID-19 should not stop their CHC suddenly without switching to other effective contraception, because that could put them at risk of unplanned pregnancy. We advise them to ask their doctor about switching to another method of contraception.
  • People using CHC should continue it when they have their COVID-19 vaccination
  • Anyone worried about risk of blood clots may consider using effective contraception other than CHC

The risk of someone having a blood clot when they are using CHC is small – much lower than the risk of having a blood clot if they were pregnant. Nevertheless, people are slightly more at risk of a blood clot when they are using CHC than they are when they are not using it, even if they are fit and healthy. The progestogen-only pill, the implant, the injection and intrauterine contraceptives do not increase risk of a blood clot.

Individuals who are very ill with COVID-19 have an increased risk of blood clots. If someone is in hospital with COVID-19, we recommend that they do not use CHC in case it increases the clotting risk even more.

We do not know what the blood clot risk is for people who have mild or asymptomatic COVID-19 infection or people who have recently had COVID-19, but it could be higher than normal. That could mean an added risk of blood clots for people that are using CHC who become infected with COVID-19.

It is really important that people do not stop their CHC suddenly because they are worried about blood clots – that would put them at risk of unplanned pregnancy. Instead, if someone has a mild COVID-19 infection, they could ask their doctor for the safer progestogen-only pill to use until they are completely well again.

People who don’t have COVID-19, but are using CHC and are worried about the risk of clots if they did get COVID-19, can speak to their contraception provider about switching to another kind of contraception. They should keep using their CHC until the new contraception is started.

Pandemic has had ‘deep impact’ on access to contraception

Latest data from NHS Digital show there has been a steep fall in access to emergency and long-acting reversible contraception throughout the pandemic.

Provisional statistics from April to September 2020 show:

  • 37% fall in contraception-related contacts with SRH services
  • Uptake of LARC has fallen to 43%, down from 46% in 2019/20
  • 53% fall in emergency contraceptive items provided by SRH services
  • 44% of contacts were non-face to face compared to 3% in 2019/20

FSRH President Dr Asha Kasliwal said: ‘Whilst the data does not cover all settings where contraception is provided, it does paint a stark picture of the impact of the COVID-19 pandemic on access to essential women’s healthcare.’

Practice Nurse 2021;51(3):8