Pills & Clots, Hills & Plots… Dr.Elizabeth Oliver

After his daughter developed a blood clot while taking the medication Diane-35, Federal MP Julian Hill last week outlined his plan to ban the drug in Australia. He is concerned that GPs are mindlessly prescribing this dangerous drug because they like the way the name sounds. Let’s review.

Diane-35 is a contraceptive pill specifically formulated to target skin. It’s prescribed for women with severe acne and body hair, with the added benefit of contraception and control of heavy periods, should the woman require either. Mr Hill revealed that the risk of blood clots, or deep vein thrombosis (DVT) on Diane-35 is double the risk of more commonly prescribed Pills.


If you monitored ten thousand women not taking any Pill for a year, between 1 and 5 of them would get a DVT. 

A woman on a commonly prescribed, ‘safer’ Pill, say Levlen, has a risk of 5 to 7 in ten thousand.

A woman taking Diane-35 has a risk of 9 to 12 in ten thousand.

For perspective, in the three months after giving birth a woman has a risk of 60 in ten thousand.

Yes, it is double the risk. Sort of. Five more out of ten thousand. But, hold on, even women on a ‘safe’ Pill are at increased risk? Double to seven times compared to no Pill at all, depending how you sell it. Immediately after giving birth, a woman has a risk six times that of Diane-35. Should we ban pregnancy? Even better, ban smoking. Let’s ban obesity. Also hip and knee surgery. All of these substantially increase the risk of DVT. International travel, banned.

Any man or woman carrying the common Factor V Leiden gene has a one in ten risk over their lifetime of developing a DVT. No woman with this condition should be on the Pill, any Pill. No person with this condition should smoke. All people with this condition should be aware of it when taking long haul flights.

Is it good that we are talking about the risks of commonly used medications? Yes. If a wave of women come in the next few weeks wanting to discuss their contraceptive choice, fantastic. But the idea that any medication which requires a nuanced approach should be ‘banned’ is tiresome and hysterical. Thirty one men died after using Viagra in the first year of its availability in the UK, and plenty more since. Should we ban Viagra? One woman per week dies of domestic violence in Australia. Shall we ban men?

Contraception, like any medication, is complex. Any woman considering the Pill should have a thorough assessment of her family history and personalised risks and benefits. She should be presented with the numbers and make an informed decision based on her own values. I see women every day who deal with the effects of contraception, lack of contraception, acne, endometriosis, pregnancy and post-pregnancy complications. The more options they have, the better.

Mr Hill has found in social media chat groups that “some young women think that this is a good pill that makes their skin nice.” I suggest that before he trivialises severe acne and passes judgement on another person’s health choices, he reviews the numbers on depression, bullying and suicide among acne sufferers. Before deciding how people should be protected from their silly aesthetic demands, he could talk to some womens’ health experts.

He states “everyone knows it’s widely prescribed as a sexy sounding first-choice contraceptive.” GPs are looking at each other in confusion. Diane-35 is known as one of the more expensive and poorly tolerated Pills and most GPs aren’t so dazzled by the PR that they prescribe it as first choice. And absolutely no offence to any Dianes or Brendas, but I don’t think they sound any sexier than Yaz, Yasmin, Zoely, Valette, Loette, Seasonique or Eleanor. I could as easily say “everyone knows taking any Pill increases your risk of DVT on a long haul flight,” but I’d be wrong, and so is he.

The risk of DVT is real in all Pills. For some women, the Pill allows them to manage their crippling endometriosis, heavy periods, period pain, and the increased cancer risk associated with the irregular periods of polycystic ovarian syndrome. No drug is completely safe, or completely evil. If we are truly concerned with the health of Australian women and their risk of DVT, we could champion the male contraceptive, a promising alternative whose study was halted in 2016 because 6% of men reported mild side effects. We could fund general practice in such a way that GPs have time to talk to their patients about drug choices. We could run a ‘vasectomy drive,’ encouraging those who have completed their families to make a non-drug choice.  All of this could help Australian women more than banning Diane-35, dangerously sexy though she may be.

That Lady Doctor