Medically reviewed by Sophia Yen, MD, MPH – Written by Pandia Health Editorial Team
Should I stop my Yaz because I got the JNJ COVID vaccine
I recently received the J&J COVID vaccine on April 4, and I just read that the FDA is advising to pause administering that vaccine due to blood clot concerns. I am currently taking Yaz bcp. Do you think I need to stop taking it for a while just to minimize my risk of blood clots? I’m worried that taking Yaz will increase my chances of getting a blood clot after getting the J&J vaccine. Please advise. Thank you very much!
The doctors at Pandia Health note your concern and appreciate you taking charge of your health. In general, you should not worry. There were only 6 cases thus far reported following the administration of over 6 million J&J doses= 1 out 1 million. That’s fewer than your risk of getting hit by lightning (1 out ot 700,0000 or of getting a blood clot from birth control pills 3-4 out of 10,000)
What we’re seeing with the vaccine is different from what we usually see in women with blood clots from birth control. The blood clots reported in the 6 cases are known as cerebral venous sinus thrombosis (CVST); in all cases, the clots were seen in combination with low levels of blood platelets, a condition known as thrombocytopenia. All occurred among women between the ages of 18 and 48, the statement from the CDC and FDA said, and symptoms occurred between 6-13 days after vaccination but may occur up to 3 weeks later. In addition to the fatal case, one of the women is in critical condition. With the pause and alerting the medical community and public, it is very possible that we may see larger numbers of complications reported later this week. Knowing what to watch for is a form of empowerment.
The CDC and FDA recommend people who have received the Johnson & Johnson vaccine who develop certain symptoms within 3 weeks of receiving the vaccine should contact their health care provider. The symptoms were listed as
- Severe headache
- Abdominal pain
- Leg pain
- Shortness of breath
Remember that the vaccine has prevented comorbidity and death related to clotting because COVID-19 infections alone can cause complications and death by producing clotting disorder/low platelets. The vaccine still has a much lower risk of causing clotting complications than using birth control pills alone and/or unintended pregnancy if one should not use contraception and become pregnant.
The mechanism of developing a clot from birth control pills or pregnancy is different than the mechanism by which the vaccine or COVID-19 infection does.
The “pause” on the J and J vaccine administration is an indicator that the medical community safety reporting system is working and that further diving into identifying what specific risk factors may be leading to an exaggerated response of the immune system and the resultant decrease in platelets and promotion of clots. The specific entity of cerebral venous sinus thrombosis (CVST) is what is being investigated. Putting COVID-19 and vaccines aside, the risk of CVST is higher in persons using oral contraceptives than nonusers.
For your peace of mind, if you are NOT sexually active and not at risk for pregnancy, it is ok to stop birth control pills if you desire for the time being. Once you stop you will have a withdrawal bleed as if you were on the placebo tablets. You are not going to do anything detrimental to your cycle by stopping.
If you are sexually active, you need to decide what you are comfortable with. The risk of blood clots with getting pregnant is 6-12 out of 10,000 women, much greater than 1 out 1 million risk of blood clot with the vaccine.
Other birth control options with lower risk of blood clots:
There are other birth control pills that are progestin-only pills but must be taken at the same time every day to be effective. Emergency contraception with Plan B or Ella would be good to have on hand if you choose that route because if you are late by 3 hrs, the progestin only pills (norethindrone) will NOT work.
Alternatively, a progestin IUD is the most effective birth control and is long-term and fully reversible. It requires a visit with your gynecologist or provider that can place an IUD. Implants such as Nexaplanon and the shot are also very effective and do not contain estrogen and considered low risk for clot formation.
Here is the link to report any side effects you may be experiencing from your vaccine. https://vaers.hhs.gov/index.html This link is again to notify the CDC of any symptoms or side effects. There may be recommendations that may follow today’s announcement concerning your second COVID-19 vaccine dose and you should be registered to receive alerts. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/safety/vsafe.html
I hope this helps put the concern into perspective. You are the first patient to ask this question thus far today but believe we will be receiving more inquiries related to vaccine and combined birth control use. As more medical knowledge becomes available, please contact us again for questions and recommendations. Thank you again for your concern and for being your best advocate.
ACOG Statement on the Johnson & Johnson COVID-19 Vaccine
The message following is from Christopher M. Zahn, MD, Vice President of Practice Activities for the American College of Obstetricians and Gynecologists (ACOG), and was developed in partnership with Laura E. Riley, MD; Richard Beigi, MD; Denise J. Jamieson, MD, MPH; Brenna L. Hughes, MD, MSc; Geeta Swamy, MD; Linda O’Neal Eckert, MD; and Mark Turrentine, MD, the authors of ACOG’s Practice Advisory on Vaccinating Pregnant and Lactating Patients Against COVID-19.
“ACOG is aware that the U.S. Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) have put the Johnson & Johnson COVID-19 vaccination program on hold out of an abundance of caution based on a possible safety signal that requires further investigation. To date, six cases of cerebral sinus venous thrombosis (CVST) have been reported among recipients of the Jonson & Johnson vaccine, out of a reported total of 6.8 million doses administered in the United States. The available data on these cases shows that all occurred in women ages 18–48 years. The clinical syndrome includes cerebral venous thrombosis associated with thrombocytopenia occurring 6–13 days post vaccination.
“This syndrome is similar to the cases reported in Europe associated with AstraZeneca COVID-19 vaccine, which is another adenovirus vector vaccine.
“Because the CDC and the FDA have placed the Johnson & Johnson vaccine program on hold out of an abundance of caution, it is not currently available for anyone, including women of reproductive age. Those who wish to be vaccinated in the interim should be aware that the Pfizer and Moderna COVID-19 vaccines remain available.”
What Obstetrician–Gynecologists Should Know
“At this time, there is no clear phenotype of women who are more or less likely to experience this rare complication. However, until there is a better understanding of the frequency and impact of this finding, it will be important to encourage pregnant and postpartum women who wish to be vaccinated to receive the mRNA vaccines: Pfizer or Moderna.
“Individuals who have been vaccinated with the Johnson & Johnson vaccine within the last 21 days who experience severe headache, abdominal pain, leg pain, or shortness of breath should seek immediate evaluation. They should be certain to communicate that they have received the Johnson & Johnson vaccine to prompt appropriate evaluation. Given the elevated risk for thrombosis experienced by women during pregnancy or the postpartum period and while using birth control pills, evaluation of acute thrombosis is commonly performed in our specialty. Rapid treatment with anticoagulation is the standard; however, this is not the same event and anticoagulation for treatment of CVST is dangerous.”
“If venous thrombosis is noted in the setting of thrombocytopenia, treatment includes intravenous immunoglobulin and other supportive care. Importantly, treatment with heparin is contraindicated in these cases.”
For more information:
acog.org
Vaccinating Pregnant and Lactating Patients Against COVID-19
This ACOG Practice Advisory addresses Vaccinating Pregnant and Lactating Patients Against COVID-19.
Centers for Disease Control and Prevention
CDC provides credible COVID-19 health information to the U.S. (49 kB)
TCTMD.com
Papers Confirm Rare Thrombocytopenia Link to AstraZeneca Vaccine
A definitive link between the ChAdOx1 nCoV-19 vaccine and these rare immune-induced events opens the door for tests and treatment.
- CDC Health Alert Network on Cases of Cerebral Venous Sinus Thrombosis with Thrombocytopenia after Receipt of the Johnson & Johnson COVID-19 Vaccine
- Joint CDC and FDA Statement on the Johnson & Johnson COVID-19 Vaccine
ACOG
emergency.cdc.gov
Centers for Disease Control and Prevention
CDC provides credible COVID-19 health information to the U.S. (49 kB)
Thanks Dr. Stephanie Culver and Dr. Sophia Yen for writing and editing this, respectively.
The above information is for general informational purposes only and are NOT a substitute for professional medical advice. Always seek the advice of your doctor/primary care provider before starting or changing treatment.