‘Blood clot risk’ if ibuprofen and hormonal contraception taken together

Women who take ibuprofen and hormonal contraception together are at higher risk of blot clots, a study has found.

New research has revealed that non-steroidal anti-inflammatory (NSAID) painkillers when taken alongside hormonal contraception could increase the risk of a venous thromboembolism, or blood clot, by fivefold.

Over a 20-year period, researchers from the University of Copenhagen looked at two million women aged 15 to 49 years in Denmark who had suffered a blood clot for the first time and had no prior history of cancer, fertility treatment or hysterectomy.

They stressed that the overall risk remained low but that given both medications’ widespread use, women should know about the possible interactions.

More than 500,000 of them had used NSAIDs, such as ibuprofen, diclofenac, or naproxen, and hormonal contraceptives at the same time.

Patients monitored for 10 years

The use of NSAIDs alone saw an extra four women in every 100,000 suffer a blood clot – a link that has been previously established.

But researchers found that women also taking what it has called high-risk hormonal contraceptives saw the rate rise to 23 in 100,000.

These included combined oestrogen and progestin patches, which are worn on the arm, vaginal rings that release oestrogen and progestin, and pills containing either 50 mg of oestrogen, or third or fourth generation progestins, such as desogestrel.

Meanwhile, they found that women on medium-risk contraceptives, which includes all other combined oral contraceptives – the most commonly prescribed in the UK – and the medroxyprogesterone injection, saw the rate rise to 11 in 100,000.

It classified progestin-only tablets, implants, and hormone intrauterine devices (coils) as low or no risk.

Patients were monitored for 10 years on average, and 8,710 suffered a blood clot, with 228 of them dying within 30 days of their diagnosis.

‘Robust link established’

Researchers said while this was an observational study with limitations, there was a “robust” link.

They added: “This nationwide study adds new knowledge on the risk of a potentially fatal event during concomitant use of two drug classes often prescribed to otherwise healthy women.”

Associate professor Morten Schmidt, Aarhus University Hospital, Denmark, said it raised “important concerns about using NSAIDs, particularly diclofenac, and high risk hormonal contraception” at the same time.

“Healthcare authorities and regulators should include these findings in their safety assessment of available over-the-counter diclofenac, and women using hormonal contraception and their clinicians should consider alternatives to NSAIDs,” he said.

Although ibuprofen is considered safe, it has also been linked to other increased risks.

The everyday painkiller has also been associated with causing stomach ulcers, oesophageal damage, and other gastrointestinal symptoms, such as heartburn, upset stomach, and bleeding.

Other studies have shown a link between taking the anti-inflammatory drug and heart failure due to it causing the kidneys to retain more salt and water in the body, and second heart attacks or strokes.

It’s also been linked to increasing the risk of chronic pain in long-term users.

The contraceptive combined pill has also been associated with health issues, including blood clots, before. Other studies have shown it slightly increases the risk of breast cancer.

Oral contraceptives are still the most common type prescribed in the UK, which includes the combined oestrogen and progestin pill and the progestin-only pill, and used by around three million women in the UK every year.