In consultation I always ask a question that surprises many patients: “What birth control are you using?” It isn’t curiosity. It’s one of the most important questions for your safety, because hormones can raise the risk of blood clots, and so can surgery.
Why does birth control matter before surgery?
While you’re asleep in the operating room, your leg muscles stop pumping blood the way they do when you walk. Blood moves more slowly and tends to clot. Add hormones like estrogen, which also promote clotting, and the risk of venous thrombosis goes up.
A clot in the leg can travel to the lungs. It’s a serious complication, but in the vast majority of cases it can be prevented. That’s why I never leave it to chance.
Do you need to stop the pill before surgery?
Some medical guidelines recommend stopping estrogen-containing contraceptives about four weeks before major surgery. In my practice I ask patients to pause hormonal methods at least one month before, and in some cases to remove the hormonal arm implant.
Two important points:
- Never stop on your own. Do it in coordination with your surgeon and the doctor who prescribes it.
- In the meantime, use a barrier method, like condoms, to avoid an unplanned pregnancy.
What is the Caprini Score?
Not every patient has the same risk, so not everyone needs the same measures. The Caprini Score adds up your risk factors for blood clots. A study of more than 1,100 plastic surgery patients showed that this scale helps identify who is at higher risk after surgery.
These are some of the factors we count:
- Hormone use (birth control or hormone therapy).
- Personal or family history of clots or thrombosis.
- History of cancer.
- Age, weight and mobility.
- Recent trauma or major surgery.
- Length of surgery: more than three hours increases risk.
How we prevent blood clots
Your score shapes a plan made for you. Depending on the case it can include compression stockings, devices that massage the legs during surgery, blood thinners and, above all, walking from day one. The higher the risk, the more complete the measures. It isn’t overkill: it’s matching prevention to your real risk.
Clot prevention is something I have studied for years, and it’s one of the reasons preparation before surgery matters so much. To see everything we do before an operation, read our guide on how to prepare 90 days before your surgery.
Frequently asked questions
Do I need to remove a copper IUD?
A copper IUD has no hormones, so it doesn’t raise clot risk. Still, tell your surgeon everything you use.
What if I forget to tell my surgeon?
They lose a key piece of information for calculating your risk. If your surgery is already scheduled, let them know as soon as possible.
When can I restart my birth control?
It depends on your surgery and your risk. Your surgeon will tell you when it’s safe.
In your consultation, which is always free, we review your full history and build your safety plan. Book your free consultation.
About Dr. JC Alvarez. Dr. Julio Clavijo-Alvarez is a plastic surgeon certified by the American Board of Plastic Surgery and a Fellow of the American College of Surgeons. He trained at the University of Pittsburgh, where he researched adipose-derived stem cells, with studies published in Plastic and Reconstructive Surgery, and he is the lead author of a national survey of 596 plastic surgeons on preventing blood clots in body contouring surgery. He is the author of Behind the Mirror.
Sources: Pannucci et al., Caprini validation in plastic surgery (2010) · Hardy et al., Aesthetic Surgery Journal (2014)
This article is for educational purposes and does not replace a medical consultation. Every case is evaluated individually and results vary.
