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Does a history of blood clots preclude future pregnancy?

By Keith Roach, M.D. on

DEAR DR. ROACH: I have a question about blood clot history and pregnancy. I'm in my mid-30s, married without children, and just experienced my first blood clot. It started in the vein on the inside of my calf but then moved to just below my knee. My doctor prescribed Eliquis after the clot moved, and I am starting to feel MUCH better.

I know to not get pregnant while taking Eliquis, but I am wondering what is best going forward. I was on hormonal birth control for 10+ years until now. I'm considering a longer-term solution that's nonhormonal, such as a copper IUD, if my new blood clot history means I'm better off avoiding pregnancy forever. For context, I don't care about experiencing pregnancy -- I appreciate that there are other ways to bring a child into our lives if my husband and I choose that path. -- K.E.

ANSWER: Blood clots in the leg come in two major types: superficial vein and deep vein thrombosis ("thrombosis" is the Greek word for "clot"). Most superficial vein thromboses are treated with elevation and anti-inflammatory medicines, with compression stockings sometimes added. However, we always are concerned that blood clots in the superficial veins can "propagate" (that is, the clot can extend) into the deeper veins. Deep vein clots are predisposed to break off and go into the lungs, a life-threatening condition called pulmonary embolism.

People with risk factors for developing blood clots are also of special concern. This includes anyone who has had a clot before; those with identified inherited risks (such as factor C or S deficiency, prothrombin gene mutation and factor V Leiden mutation); and especially in your case, a woman who is on hormonal birth control. Because of your anatomy of the clot and the hormonal treatment, treatment with anticoagulation is a very reasonable option.

I absolutely agree that nonhormonal forms of birth control are best for you. Oral estrogens are out, and an IUD is an excellent choice. Your question about avoiding pregnancy forever is a longer discussion, and consultation with a hematologist and a gynecologist is appropriate. Most women with a history of blood clotting do well with pregnancy, although some might need medication to prevent blood clotting during pregnancy. I do not think a history of a blood clot, which is probably related to the birth control pill, means that you need to never get pregnant.

DEAR DR. ROACH: I have taken one Benadryl at bedtime for the past two plus years. I sleep seven hours and feel rested the next day. Most nights I need to get up during the night to use the bathroom and rarely have trouble going back to sleep. Recently I have read/heard that the active ingredient in this medicine has a destructive effect on memory, especially for the elderly. I am 83 years old and concerned about memory loss, although I haven't displayed symptoms of said loss. When I asked my internist about this, he indicated no problems with my continued usage of one Benadryl at bedtime. What are your thoughts? -- L.S.

 

ANSWER: The risk of memory loss due to Benadryl appears to be small. I do not recommend Benadryl for regular use because for many people, it worsens the quality of sleep and they do not feel well-rested. Further, there is evidence that regular use of Benadryl increases risk of motor vehicle accidents for seniors who drive. Even though you are doing well and feel rested, I still recommend sleep hygiene techniques as a first line treatment.

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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.

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