Hormonal Contraception and Massive Pulmonary Embolism in a COVID-19 Ambulatory Patient: A Case Report

Abstract

Coronavirus 19 disease (COVID-19) presents a highly variable clinical presentation and course, ranging from asymptomatic patients to rapidly progressive, fatal pneumonia. The known heterogeneous outcomes can affect both previously healthy patients and those with significant comorbidities, who develop clinical courses with possibly more multisystemic compromise. Likewise, the development of thrombotic phenomena during the acute course of the disease is associated with complications that worsen patient prognosis. We present a case report of a 45-year-old multiparous patient with a history of overweight and chronic use of oral hormonal contraception with low doses of levonorgestrel and estradiol as the only risk factors favoring the development of thrombotic events. During her outpatient COVID-19 clinical course, she developed massive pulmonary thromboembolism resulting in secondary obstructive shock, which required pharmacological thrombolysis. At discharge, hormonal contraception was considered contraindicated, and the patient was released from our institution with continued oral anticoagulant therapy. COVID-19 infection, contraceptive hormone therapy, and overweight are known risk factors for the development of thromboembolic events. The impact of their concomitance has not been studied to date. From our experience, we discuss the impact these risk factors have when present together and invite others to report similar cases.

SARS-CoV-2 infection, hormonal contraception and pulmonary embolism in a 17-year-old female patient

“…In the described patient, the embolism was due to an overlap of several unfavourable circumstances, namely the girl had a history of coronavirus infection and was also on hormonal oestrogen contraceptives to treat acne vulgaris (11,12) . Significantly increased IgG antibodies, as well as hair loss, which may be one of the distant symptoms of COVID-19 disease, confirmed the past SARS-CoV-2 infection.…”

“…Valenzuela-Vallejo et al described a case of a 45-year-old overweight (another risk factor for thrombosis) woman infected with SARS-CoV-2, a long-term user of COCs, the active ingredients of which were levonorgestrel (synthetic progestogen and also a component of single-component or combined contraceptive pills) and oestradiol (one of the three natural estrogenic hormones), who presented with symptoms of shock due to massive PE requiring thrombolysis. The authors discussed the impact of risk factors on the development of embolism and emphasised the need for reporting similar cases (11) .…”

“…These are alarm signals that should not be ignored, and acute PE should always be ruled out in such cases (10) . There is also data showing an increased incidence of embolism in women using combined oral contraceptives (COCs) containing oestrogens (11,12) . In the presented case, PE may have been promoted by COVID-19 and the use of oestrogen contraception for the treatment of acne vulgaris.…”

A Scoping Review of Unmet Family Planning Needs in Young Couple: Effects of Socio-Demographic Factors, Parity, and Health Services

“…The role of the midwife in this determinant may increase women's desire to visit contraceptive services. Research conducted in Indonesia showed that the role of midwives can increase women's desire to visit contraceptive services and can increase the need for contraception (Valenzuela-Vallejo et al, 2021).…”