We have known for decades that combination estrogen-progestin contraceptives increase the risk of VTE. Importantly, this incease risk is substantially less than the risk of VTE associated with childbirth. When educating providers and women , describing the the impact of pregnancy (the condition contraception is used to prevent) as well as the contraceptive method is critical to making sound choices contraceptive choices.
All Combined Oral Contraceptives Increase Risk for Venous Thrombosis, Meta-Analysis Concludes — Physician’s First Watch
All Combined Oral Contraceptives Increase Risk for Venous Thrombosis, Meta-Analysis Concludes
By Cara Adler
Taking any generation of combined oral contraceptives more than doubles the risk for venous thromboembolism, according to a BMJ meta-analysis.
The analysis included 26 observational studies of healthy women taking different combined oral contraceptives.
The VTE incidence in non-users was approximately 0.02% to 0.04% (2 to 4 per 10,000). Overall, women taking a combined oral contraceptive were nearly four times more likely to develop a first VTE than non-users. Risk increased with higher doses of ethinyl estradiol and varied with type and dose of progestogen. All generations of progestogens conferred increased risk. Risk was highest with 50 micrograms ethinyl estradiol plus levonorgestrel (relative risk, 5.2) and lowest with 20 micrograms ethinyl estradiol plus either levonorgestrel or gestodene (RR, 2.2). (Gestodene formulations are not available in the U.S.)
The authors note that the levonorgestrel intrauterine device is a birth control option that does not increase risk for VTE. For women who prefer oral contraceptives, the authors recommend those with low risk and good compliance, such as 30 micrograms ethinyl estradiol plus levonorgestrel.