The pill and cosmetic surgery at a glance
- ConcernedContraceptives containing oestrogen
- Stop4 to 6 weeks before
- RestartAt least 15 days after returning to normal activity
- While stoppedCondoms
- Can be keptProgestogen-only pill, implant, IUD (coil)
- DecisionSurgeon and anaesthetist
The combined (oestrogen-progestogen) pill, like the contraceptive patch and the vaginal ring, increases the risk of phlebitis (deep vein thrombosis) and pulmonary embolism: the 2024 guidelines of the French Society of Anaesthesia and Intensive Care (SFAR) list this “oestrogen hormone therapy” among the risk factors for phlebitis after surgery. It is therefore stopped, usually 4 to 6 weeks beforehand, for the longest or most extensive procedures (abdominoplasty, liposuction, body lift, breast reduction, thigh and arm lifts), and before any procedure if another risk factor is present. The progestogen-only pill, the implant and IUDs can be kept. While the pill is stopped, condoms are needed. The surgeon and the anaesthetist decide with you.
Article from 2015, updated with the 2024 SFAR guidelines.
1. Why is the pill a problem?
The oestrogen in the pill (ethinylestradiol) promotes blood clotting. It increases the risk of a clot forming in the deep veins of the legs (phlebitis or deep vein thrombosis), which can travel to the lungs (pulmonary embolism). Surgery, especially a long operation, and the immobility that follows already increase this risk: the two add up. The 2024 SFAR guidelines list oestrogen hormone therapy among the moderate or minor risk factors for phlebitis after surgery.
Choosing a qualified, experienced and reputable surgeon reduces these risks, and in some cases eliminates them.
2. Which contraceptives should be stopped, and which can be kept?
| Contraceptive | Contains oestrogen | Before a higher-risk procedure |
|---|---|---|
| Combined (oestrogen-progestogen) pill | Yes | Stop 4 to 6 weeks before |
| Patch, vaginal ring | Yes | Stop, as for the pill |
| Progestogen-only pill (mini-pill) | No | Can be kept |
| Contraceptive implant | No | Can be kept |
| Hormonal or copper IUD (coil) | No | Can be kept |
If you are unsure about your contraceptive, bring its box or its name to the consultation.
3. Which procedures are concerned?
Stopping is advised before the longest or most extensive procedures: surgery after major weight loss, abdominoplasty, liposuction, body lift, breast reduction, thigh lift and arm lift.
Before a lighter procedure, it is only considered if other risk factors for phlebitis are present. The 2024 SFAR guidelines distinguish:
Major risk factors
- a personal history of phlebitis or pulmonary embolism;
- known major thrombophilia;
- active cancer (treated within the last 6 months);
- severe obesity (body mass index of 40 or more).
Moderate or minor risk factors
- age 75 or over;
- heart or respiratory failure, chronic obstructive pulmonary disease;
- severe kidney failure;
- chronic inflammatory disease (rheumatoid arthritis, inflammatory bowel disease, lupus…);
- oestrogen hormone therapy (combined pill, patch, ring, menopause treatment);
- current pregnancy or recent childbirth;
- obesity (body mass index of 30 to 40);
- recent prolonged bed rest;
- a neurological deficit of less than one month (stroke, spinal cord injury);
- immobilisation or bed rest after the procedure.
Smoking is not on this list, but it increases wound-healing complications and must be stopped before any procedure (see the article on smoking).
4. When to stop and when to restart the pill?
The pill is usually stopped 4 to 6 weeks before the procedure. The SFAR guidelines do not set a time frame; the figure of at least 4 weeks comes from the British guidelines (NICE). The pill is restarted at the beginning of a cycle, at least 15 days after you are walking and back to normal activity, once the risk of phlebitis linked to the procedure has passed. The surgeon and the anaesthetist will give you the dates.
5. Staying protected while the pill is stopped
Stopping the pill means stopping your contraception: use condoms throughout the whole period. Pregnancy must be ruled out before the procedure; if in doubt, let us know.
If you keep taking your pill, be aware that if you vomit in the hours after taking it, after the anaesthetic for example, it may not be absorbed: follow the instructions in the leaflet or ask your pharmacist for advice.
6. What about hormone replacement therapy for the menopause?
The 2024 SFAR guidelines count it, like the pill, as “oestrogen hormone therapy”, a risk factor for phlebitis. Whether to stop it before the procedure is therefore considered in the same way as for the pill: tell the surgeon and the anaesthetist about it.
7. Preventing phlebitis around the time of surgery
Whatever your contraception, the anaesthetist and the surgeon assess your risk of phlebitis according to the procedure and your risk factors. According to the 2024 SFAR guidelines:
- walking within the first 24 hours after the procedure is part of prevention;
- after a low-risk procedure, one major risk factor or several minor factors lead to an anticoagulant being offered, by injection, for at least 7 days;
- day surgery reduces the risk, but does not on its own remove the need for prevention when it is required.
Compression stockings may be added, depending on the procedure.
Frequently asked questions
Do you always have to stop the pill before cosmetic surgery?
No. Stopping is advised before the longest or most extensive procedures, and before any procedure if another risk factor for phlebitis is present. The surgeon and the anaesthetist decide with you.
How long before the operation should I stop the pill?
Usually 4 to 6 weeks before the procedure.
Do I need to have my IUD or implant removed?
No. IUDs, hormonal or copper, and the implant contain no oestrogen: they can be kept.
How do I protect myself while I am off the pill?
With condoms, throughout the whole period. Pregnancy must be ruled out before the procedure.
When can I restart the pill?
At the beginning of a cycle, at least 15 days after you are walking and back to normal activity. The surgeon and the anaesthetist will give you the date.
Do antibiotics make the pill ineffective?
Most do not. Only certain antibiotics, such as rifampicin, reduce its effectiveness.
Sources
- Groupe d’intérêt en hémostase péri-opératoire (GIHP), Société française d’anesthésie et de réanimation (SFAR), Société française de thrombose et d’hémostase (SFTH), Société française de médecine vasculaire (SFMV). Prevention of perioperative venous thromboembolism: update of the 2011 SFAR formalised expert recommendations. 2024; published in Anaesthesia Critical Care & Pain Medicine, 2024.
- National Institute for Health and Care Excellence (NICE). Venous thromboembolism: reducing the risk.
- Chattha A, Brown E, Slavin S, Lin S. Oral Contraceptive Management in Aesthetic Surgery: A Survey of Current Practice Trends. Aesthet Surg J. 2018;38(3):NP56-NP60.
See also: Why stop smoking before cosmetic surgery? · anaesthesia in cosmetic surgery · How to prepare your skin before cosmetic surgery