My Birth Control Almost Killed Me

How two years of oral contraceptive use changed the trajectory of my life at 18 years old

Photo by Olivia D'Andrea, 2023

This is a piece from April 2024 for an Intermediate Feature Writing class at Fordham University.

My freshman year of college was surely a time to be alive. I made plenty of new friends, ate highly questionable dining hall food, and secured the coveted 4.0. The thrill of freedom tasted like the underage consumption of a warm strawberry lemonade hard seltzer on a Friday night. Despite starting during a pandemic, my freshman year of college was a time to be alive until I almost died.

I heard sirens getting louder as my trembling hands struggled to pick up my phone.

“Hello, Olivia? The health center is sending over an ambulance for you. We’re gonna send a stretcher up to your floor, okay?”

I stumbled down the stairs of my dorm to an ambulance waiting with its doors wide open as the university EMT trainees scrambled. I crawled into the back with my head down praying I’d remain anonymous to the curious onlookers. I was rushed to the children’s ward of the local hospital, where I spent twelve agonizing hours alone, in pain, and terrified.

In the years before college, I struggled with severe acne. My 12-year-old self prayed for miracles while Googling ‘how to get rid of pimples overnight’ on the family computer after everyone else went to bed. With Crest toothpaste slathered all over my face in hopes of the laughable red targets miraculously disappearing from my face, I begged my mom for a dermatologist appointment. Month after month and topical cream after topical cream, the acne persevered. It was sixth grade when I grew a mountain on the tip of my nose that no amount of Nars creamy concealer could cover.

“Hey, Rudolph!” shouted a girl in my home ec class across the table.

By high school, I enrolled in a private school and had made the varsity football cheer team. We spent our summers practicing at the captains’ houses before the season’s official start. After practice, we sat around the pool, sharing stories and laughs over dinner as the summer sunset encroached. On one particularly muggy July night, a slew of iPhone alarms blared in a unison fortissimo like a professionally trained orchestra. It was 8 pm.

“BC time,” one girl said with a chuckle.

“Time for the pill,” said another as she reached for her purple monogrammed drawstring bag.

The pill? I thought to myself.

I idolized these older girls on the team. The effortlessly beautiful and petite girls with their gleaming hair and their no-makeup looks popped birth control pills like candy. So, that meant I needed to go on the pill. My acne was stubborn, and Google told me that combination oral contraceptives could be an effective treatment for hormonal acne.

Almost one in five U.S. women use birth control for reasons other than preventing pregnancy, like better managing their periods or managing hormonal acne (Frederiksen et al.). Combination oral contraceptives refer to the combination of estrogen and synthetic progesterone proven to be effective in treating acne. The FDA has approved only three types of birth control for acne: Ortho Tri-Cyclen (estrogen and norgestimate), Estrostep (estrogen and norethindrone), and YAZ (estrogen and drospirenone) (Taylor).

The remainder of my junior year of high school was riddled with SAT-induced anxiety and my dad’s first cancer diagnosis. It’s no wonder the stress was showing on my skin. My mom was hesitant, but I eventually talked her into the benefits of birth control for acne. I met with my doctor for less than ten minutes before she prescribed some off-brand oral contraceptive and spewed the side effects at me at lightning speed in one breath.

Nausea, headaches, depression, weight gain, irregular periods, mood changes, blood clots.

The average time a patient spends with a primary care physician is 13-16 minutes. For an OB/GYN visit, that average is 9-12 minutes (Wood). Surely, my doctor couldn’t get to know me that quickly.

But my acne would disappear, and that’s all that mattered. No prior testing required, no prior questionnaires. The prescription was sent on its way, and so was I.

A recent study revealed that oral contraceptive users had the highest rate of switching (35.5%) or discontinuing (36.8%) birth control use after six months compared to other methods because of complications or side effects (Simmons et al.).

But it felt like I struck gold, won the lottery, and was elected president all at the same time. I was on cloud nine, unreachable by the side effects. I felt invincible.

This invincibility grew stronger as my skin became clearer. My alarm sounded at 8 pm every night, signaling the delicate entanglement of confidence in a pill and a newfound sense of femininity. It was almost too easy.

For two years, my skin was radiant and utterly low-maintenance. I feared the transition to college would wreak havoc on my face, but instead, it decided to wreak havoc on my body.

Instead of the default iPhone alarm waking me up on March 12, 2021, a deep, stabbing pain in my side greeted me that morning. It was a Friday and the last day of midterm week. My Spanish oral exam was scheduled for later that day.

I tossed and turned in my twin XL bed for another hour. It was 6 am, and I was alone in my dorm room. The worst thing you can do as a college student in New York City is call your mom crying at an obscure hour. I mustered up the strength to do just that.

“Mom, I, like, can’t breathe,” I said as my voice cracked.

My mother, being jolted out of bed by the sheer sound of my cries, was a hundred miles away at home, unable to do much of anything at all – a parent’s worst fear. She woke my dad, who called his cardiologist sister, my Aunt Linda, and told her to call me.

Within the first 30 seconds of the call with my aunt, she asked if I was on hormonal contraceptives. I felt a strange sense of shame having to tell a relative I was taking a drug strictly for vanity purposes.

She urged me to go to the emergency room and ask doctors to run a D-Dimer test. My anxiety convinced me to downplay the severity of my inability to breathe. I didn’t want to go to the ER. Instead, I walked to the university health center. There, I described my symptoms and was told I simply pulled a muscle in the gym. I was given ibuprofen, a bottle of water, and a quick dismissal with a courteous smile. With my vision tunneled and my chest tight, I trudged back to my dorm room and mustered the strength to call my mom once more. She immediately sent an ambulance this time.

I grew weaker as my breaths became more labored, and the taste of metallic blood grew more potent in the back of my throat. Before I knew it, I was hooked up to an IV in the emergency room, where the sharp wailing of young children was the only thing keeping me conscious.

I mentioned the D-Dimer test to the nurses as soon as I arrived.

“I mean, we’ll run it, but why would a healthy 18-year-old have blood clots?” I overheard one of my nurses say to the other.

I think I took about eight pregnancy tests. Negative. Ultrasound after x-ray, I left the doctors stumped. It was 2 am when the blood work taken six hours prior came back. Abnormal. I signed the discharge papers in a less-than-legible signature and drove home to Pennsylvania with my parents. With the morphine worn off, I cried in pain the entire two-and-a-half-hour drive before going to the hospital at home.

Within a half hour after my CT scan, the ER doctor knocked twice and entered the small room.

“Well, you’ve got bilateral pulmonary embolisms. Blood clots in both of your lungs.”

I laughed.

What do you mean a healthy 18-year-old has blood clots in her lungs?

The cause? My birth control.

Doctors frequently promote newer pills to young women and teenagers as a preferred option that can help alleviate acne and prevent weight gain. More recent types of birth control pills containing substances like drospirenone may elevate the risk of blood clots up to 1.8 times compared to older versions (Huston). Venous thromboembolism (VTE) risk increases with a high ethinyl estradiol dose and 3rd or 4th generation progestin. Drospirenone is recognized as a 4th generation progestin. (Cooper et al.). Sure enough, the active ingredients in my birth control were drospirenone, ethinyl estradiol, and levomefolate. I’d later find out this combination was an inevitable disaster.

I placed all of my adolescent trust in a pill that promised me more, but how would I know better? According to the National Library of Medicine, thrombosis occurs “within one year in about 9 to 12 out of 10,000 women who regularly take a birth control pill containing drospirenone.” And in comparison, VTE occurs in about 2 out of 10,000 women who aren’t taking contraceptives.

So, I swapped my birth control for a blood thinner.

I spent two weeks home from college, dreading every follow-up appointment. My hematologist ran a medically necessary genetic panel revealing that I had the heterozygous Factor II genetic mutation. This dangerous blood clotting disorder predisposes me to pulmonary embolisms (PEs) and deep vein thrombosis (DVT). I inherited the gene from my mother’s side.

Though I’m grateful I discovered this early in my life, making the connection shouldn’t have taken a hospitalization. In 2021, a 24-year-old New Zealand makeup artist was found dead in her home after complaints of back and leg pain. She died of a previously unknown disorder called heterozygous Factor V Leiden mutation, which increases the risk of blood clots. Her use of oral contraceptives exacerbated this condition, leading to her death (Neal). Factor II and Factor V are very closely related. Prior genetic testing could have prevented her death. Prior genetic testing could have prevented my hospitalization.

In the three years since my experience, I’ve urged those closest to me – especially my female cousins – to be aware of the warning signs. Interestingly, one of my mom’s brothers was recently diagnosed with Factor II after being hospitalized for a blood clot.

Had I known of my blood clotting disorder, I would’ve steered clear of any hormonal contraceptives. Had my 12-year-old self Googled more about the potentially fatal side effects of birth control, she wouldn’t have asked her mom about it years later. Had a simple saliva-based genetic testing sequence been done before I was prescribed birth control, I would have known my risk. At-home genetic test kits are becoming more popular. But this means they are becoming more expensive and thus less accessible. Most insurance companies won’t cover the cost of these kits because they’re deemed not “medically necessary” (National Library of Medicine).

I shouldn’t be a statistic. Ideally, doctors would run total genetic panels on every female seeking a birth control prescription at a cost covered entirely by insurance or at a fair price low enough for those without private medical coverage. Knowing life-saving information about my own body is medically necessary. There shouldn’t be a paywall for vital health information.

Our days are not promised. Often, the deadliest risks hide behind the prettiest promises. In the quiet aftermath of my youthful innocence shattered by hospital walls and genetic revelations, I found myself standing at the intersection of femininity and mortality.

Had I known I’d be popping blood thinners like candy for the rest of my life, I would’ve never started birth control.

Works Cited

Cooper, Danielle B., et al. “Oral Contraceptive Pills - StatPearls.” NCBI, 24 November 2022, https://www.ncbi.nlm.nih.gov/books/NBK430882/.

Frederiksen, Brittni, et al. “Women's Sexual and Reproductive Health Services: Key Findings from the 2020 KFF Women's Health Survey.” KFF, 21 April 2021, https://www.kff.org/womens-health-policy/issue-brief/womens-sexual-and-reproductive-health-services-key-findings-from-the-2020-kff-womens-health-survey/.

Huston, Andrea. “Birth Control and Blood Clots: A simple genetic test can help predict your risk.” Pillcheck, 18 June 2020, https://www.pillcheck.ca/2019/01/15/birth-control-and-blood-clots/.

National Library of Medicine. “How much does direct-to-consumer genetic testing cost, and is it covered by health insurance?” MedlinePlus, 21 June 2022, https://medlineplus.gov/genetics/understanding/dtcgenetictesting/dtccost/.

National Library of Medicine. “Which birth control pills can help reduce acne?” NCBI, 16 January 2013, https://www.ncbi.nlm.nih.gov/books/NBK279209/.

Neal, Tracy. “Young makeup artist on contraceptive pill dies from blood clot.” NZ Herald, 28 November 2023, https://www.nzherald.co.nz/nz/young-makeup-artist-on-contraceptive-pill-dies-from-blood-clot/5ZCDGEFB4FFYPM4IYE6VHQY2WQ/.

Simmons, Rebecca G., et al. “Predictors of contraceptive switching and discontinuation within the first 6 months of use among Highly Effective Reversible Contraceptive Initiative Salt Lake study participants.” NCBI, 18 December 2018, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6861011/.

Taylor, Rebecca Buffum. “Birth Control for Acne Treatment: Types, Benefits, Risks.” WebMD, 6 March 2024, https://www.webmd.com/skin-problems-and-treatments/acne/birth-control-for-acne-treatment.

Wood, Debra. “Average Time Doctors Spend With Patients.” AMN Healthcare, 23 June 2023, https://www.amnhealthcare.com/blog/physician/locums/average-time-doctors-spend-with-patients/.