prevention
November 5, 2012 | 20,00 EUR | answered by Dr. med. Ralf Berg
Dear Sir or Madam,
Years ago, I was advised by a gynecologist not to use any hormonal contraceptive methods. This recommendation was based on the results of a blood test which revealed the following:
- Indication of Factor V Leiden mutation
- Present mutations 677T and 1298C in the MTHFR gene
- Protein S deficiency
In March 2012, I had a fibroid removed and during this procedure, I had a discussion with a gynecologist who believed that there are indeed safe contraceptive options available based on the following factors:
- Non-smoker
- Very rare alcohol consumption
- Regular exercise
- etc.
He mentioned a NuvaRing, which I have already tried but did not tolerate well. I wanted to inquire about the second option he mentioned. He talked about pills that could also be taken in this case. I believe he referred to progestin-containing preparations. There may be other options available as well. As far as I can remember, he mentioned Cerazette.
Please let me know if I could actually take such a medication, or if there is another contraceptive in this category that I could use. Thank you in advance for your efforts.
Sincerely,
Dear Inquirer,
Cerazette (original manufacturer MSD) is a progestin-only contraceptive pill (without estrogen) and is also produced and offered by many generic manufacturers. It contains only 0.075 mg of a progestin (specifically Desogestrel) which is well tolerated and still achieves reliable contraception. In my opinion, you can use this method of contraception.
Generally, there is an increased risk of thrombosis with hormonal contraception. This risk is further increased in young women by smoking, inadequate fluid intake, and lack of physical activity. These are things that do not apply to you anyway. With your mutation in the MTHFR gene, there may be an increased tendency for coagulation and therefore thrombosis, if it leads to a clinically relevant protein S deficiency. Question: Has Protein S in your serum ever been determined?
Only if this mutation actually leads to decreased Protein S levels in you is this clinically relevant. Unfortunately, I do not know your age, but apparently you have not had any thrombosis or pulmonary embolism so far, right? From your description, I conclude that you have not been advised to start anticoagulation therapy (i.e. take blood thinners) either. Your risk of thrombosis is therefore low. The hormone estrogen, which is present in many contraceptive pills, can promote the formation of thrombosis. However, this should be avoided by using a progestin-only pill, especially in a low dosage.
Overall, I agree with the second gynecologist, especially because you do not engage in the classical additional risk behaviors, that you can use this form of contraception. In my opinion, your risk of thrombosis is hardly increased by this.
Best regards,
Dr. R. Berg
I hope I was able to answer all of your questions. If not, feel free to ask.
