picture showing test tubes and a diagnosis of antiphospholipid syndrome.Understanding Antiphospholipid Syndrome (APS) and Its Impact on Women’s Health

Antiphospholipid Syndrome (APS) is an autoimmune disorder that significantly impacts blood clotting and disproportionately affects women. Despite being a significant cause of blood clots, miscarriage, and pregnancy complications, APS remains underrecognized, especially among young women. Understanding APS is crucial for informed healthcare decisions, especially when it comes to reproductive health and contraception.

What Is APS?

Antiphospholipid Syndrome is an autoimmune condition in which the body mistakenly produces antibodies against phospholipids or the fatty molecules that play a key role in cell membranes and blood clotting. These antibodies increase the risk of abnormal clot formation in veins and arteries, leading to complications such as:

  • Deep vein thrombosis (DVT)
  • Pulmonary embolism (PE)
  • Stroke or transient ischemic attacks (TIAs)
  • Recurrent miscarriages or stillbirth
  • Pregnancy-related complications like preeclampsia or placental insufficiency
Why APS Matters in Women’s Health

doctor talking to patientWomen are more likely than men to be diagnosed with APS, and the condition often presents during the reproductive years. This is particularly important because hormonal changes, contraceptive use, and pregnancy can all influence clotting risk. For women with APS, careful management is essential to reduce the risk of serious health events.

APS may be diagnosed after a major clotting event or recurrent pregnancy loss. It is sometimes associated with other autoimmune disorders, such as lupus, but it can also occur on its own (primary APS).

APS and Contraceptive Choices: What Women Need to Know

One of the most critical areas where APS intersects with women’s health is in contraceptive decision-making. Certain birth control methods, particularly those that contain estrogen, can increase a woman’s risk for blood clots — a risk that is already elevated in individuals with APS.

High-Risk Contraceptive Methods for APS Patients

Combined hormonal contraceptives (CHCs) include most birth control pills, patches, and vaginal rings, and CHCs contain estrogen and progestin, which together raise the risk of blood clots. Hormonal birth control methods like these are generally not indicated for use among women with APS due to the heightened risk of serious clotting complications.

Safer Alternatives for Women with APS

Women with APS or a history of blood clots should discuss safer, non-estrogen options with their healthcare provider. These include:

  • Progestin-only methods
    • Progestin-only pills (mini-pill): Taken daily and do not contain estrogen.
    • Progestin-only IUDs: Offer long-term pregnancy prevention with minimal systemic hormone absorption.
    • Progestin-only injectable contraception: Requires regular dosing every three months but may slightly increase clot risk and requires individualized assessment.
    • Progestin-only implants: Long-acting and low systemic hormone levels.
  • Non-hormonal methods
    • Copper IUD: Highly effective, hormone-free.
    • Barrier methods: Condoms, diaphragms, or cervical caps are safe but may have lower effectiveness without perfect use.
    • Fertility awareness methods: Can be used if acceptable, though they require diligence and are less effective.
Living Well with APS: The Importance of Individualized Care

young couple holding newbornBecause APS is a complex condition, care must be tailored to each woman’s health history, clotting risk, lifestyle, and reproductive goals. This includes:

  • Collaborating with specialists such as hematologists, rheumatologists, and gynecologists.
  • Monitoring antibody levels and managing clot risk with medications anticoagulants when appropriate.
  • Preconception counseling and pregnancy planning for women who wish to become pregnant.

APS is a serious but manageable condition when diagnosed early and treated properly. For women, especially those considering contraception or pregnancy, understanding APS and making informed health decisions can significantly reduce the risk of complications.

At the Rowan Foundation, we are committed to raising awareness of clotting conditions like APS and empowering women with the knowledge they need to protect their health. If you have a history of blood clots, autoimmune disease, or pregnancy complications, talk to your doctor about testing for APS and discussing the best contraceptive options for you.

APS RESOURCES

Blood Clot Recovery Network, for personal perspectives and insights about APS and recovery following a blood clot diagnosis.

APS Foundation of America, for detailed information and education about APS.

APS Support UK, a nonprofit organization based in the United Kingdom that works to achieve early APS diagnosis and support anyone affected by APS through awareness, education, and research.

Learn more about hormonal versus nonhormonal contraception options.