Advertisement

All Combined Oral Contraceptives Increase Risk for Venous Thrombosis, Meta-Analysis Concludes — Physician’s First Watch

Medical News |
September 16, 2013

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.

Reader Comments (1)

ANDREW KAUNITZ Physician, Obstetrics/Gynecology, University of Florida College of Medicine-Jacksonville, Editor-in-Chief NEJM Journal Watch Women's Health
Competing Interests: My department receives research funding for clinical trials and I participate on Advisory Boards for several companies which manufacture hormonal contraceptives.

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.

Your Comment

(will not be published)

Filtered HTML

  • Allowed HTML tags: <a> <em> <strong> <cite> <blockquote> <code> <ul> <ol> <li> <dl> <dt> <dd>
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.

Plain text

  • No HTML tags allowed.
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.
Do you have any conflict of interest to disclose?
CAPTCHA
This question is for testing whether you are a human visitor and to prevent automated spam submissions.
Image CAPTCHA
Enter the characters shown in the image.

Vertical Tabs

* Required

Reader comments are intended to encourage lively discussion of clinical topics with your peers in the medical community. We ask that you keep your remarks to a reasonable length, and we reserve the right to withhold publication of remarks that do not meet this standard.

PRIVACY: We will not use your email address, submitted for a comment, for any other purpose nor sell, rent, or share your e-mail address with any third parties. Please see our Privacy Policy.

Advertisement
Advertisement
Advertisement