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Thursday, October 21, 1999 Published at 13:07 GMT 14:07 UK


Women 'can take pill before surgery'

HRT and the contraceptive pill can complicate surgery

Women can safely continue to take the combined contraceptive pill or hormone replacement therapy (HRT) before surgery despite medical advice to the contrary, the Consumers' Association (CA) has said.

Women taking combined oral contraceptives or HRT are at increased risk of developing blood clots in the leg veins and in the lung (venous thromboembolism).

This risk is further increased following major operations or leg surgery, and particularly after emergency surgery.

To reduce the risk, standard advice from manufacturers to women on a combined oral contraceptive is to stop the pill temporarily, from four to six weeks before planned surgery. This advice is backed up by the Medicines Control Agency.

However, the CA says such a change may be unattractive to women and could result in pregnancy if a woman does not use alternative contraception.

Surgeons need to be fully aware whether or not a woman is pregnant before she goes into the operating theatre, as surgery and anaesthesia can pose a risk to a foetus.

Treatment can prevent clot risk

In its publication Drug and Therapeutics Bulletin (DTB), the CA suggests women need not stop the pill provided they are given treatment to help prevent venous thromboembolism.

This involves wearing special elastic stockings and having injections of the drug heparin, which thins the blood and reduces the risk of clot formation.

In general, manufacturers of HRT advise that the treatment should be stopped temporarily from four weeks before surgery that is likely to be followed by prolonged immobilisation.

But DTB suggests that women on HRT should continue to take the treatment around the time of major surgery or leg operations, provided they receive the same sort of anti-clotting treatment as suggested for those on the combined oral contraceptive pill.

Joe Collier, editor of DTB, said: "Women on the combined oral contraceptive who are due to have a major operation should be given the choice of whether or not to temporarily stop the pill.

"Also, women on HRT do not need to stop taking this treatment from a few weeks before surgery."

Professor Neil Poulter, of University College Hospital, a specialist in contraception and hypertension, said it was very difficult to be dogmatic about the benefits of coming off the pill prior to surgery.

He said it was true that the risks of venous thromboemobolism could be reduced with effective treatment, but warned that the risk could not be eradicated.

Professor Poulter said: "It is extremely difficult to evaluate the risks of venous thromboembolism against the risks of getting pregnant.

I would not take a fixed view, you have got to assess each individual on an individual basis."

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