Small chances are big deals when your life is on the line

Photo by Casey Gomez

I have taken birth control pills since I was 13 years old. I have also taken several statistics classes. Recently, those two facets of my life collided rather unpleasantly.

I went to Stamps in mid-February to get a new prescription for my current supply of combination birth control pills, which I use and have used for seven years now to control the normal hormonal fluxes which for me lead to migraines. Lots of other things — hot weather, fluorescent lights and stress among them — are triggers for my “migraine-with-aura” episodes, which are the typical crippling pain and nausea of migraines preceded by partial or complete blindness. Sometimes they even happen out of nowhere. However, on birth control I can ensure that I am not out of commission for days at a time at my ovaries’ behest.

Stamps, as it turned out, would not prescribe me the combination pills. The CDC, on a colorful matrix of medications and medical conditions, ranks “migraine-with-aura” coupled with “combination contraceptive pills” as a level four risk on a scale of four. That box on the matrix is bright red. “Unacceptable health risk, method not to be used.” Between the neurological dysfunction that leads to migraine-with-aura and the synthetic estrogen present in combination pills, my risk of having a stroke is elevated beyond the point that the CDC, the WHO and most medical professionals think is justified.

The average woman, according to the most commonly cited data, has a 1.3 in 100,000 chance of having a stroke in any given year. For women with migraine-with-aura, that chance more than quadruples, putting the stroke risk on par with the risk of dying in a motor vehicle accident. Women with that condition who take the combination pill nearly quadruple their risk again, coming out to a 28 in 100,000 chance of having a stroke. Anyone with an understanding of numbers can confirm that a 0.028 percent chance of anything is essentially negligible, but the unnecessary elevation is not worth the potential benefits in the minds of prominent doctors.

Somewhere in the back of my mind, the link between these three things seemed familiar, but seeing and hearing the facts in-person was harrowing. No pediatrician or gynecologist at any point in my life had seen fit to mention this or abide by it, though whether for lack of knowledge or lack of concern it is unclear. As a young woman who is otherwise healthy and does not smoke, my other risk factors for stroke may have been low enough that the increased threat feels negotiable. Even now, in talking to three separate doctors, it has been made clear to me that I can elect to pursue the combination pills if I (ideally in conjunction with a neurologist) feel that other options would drastically decrease my quality of life.

I know a woman who died in a car crash and rationally understand that her death does not mean I am “beating the odds” or overdue for an ischemic episode. But the fleeting thought, especially as I continue taking the pills as an interim measure, continues to find me. In considering other options, I am not convinced that something without supplemental estrogen could provide the control and predictability that I have grown used to. That said, I am also not convinced that the level of control is worth it, much less that it will be sustainable as I enter my twenties and thirties.

I am not yet sure how my approach to migraine treatment will change, if at all, though the plan this summer is to consult with more doctors and experiment with alternatives. In any other facet of my life, I would hardly consider a .028 percent chance of something bad happening as noteworthy.

However, maybe as a result of the gravity placed on that number by professionals, and maybe out of the very human desire to not die, this number feels different.