Oral contraceptives and cardiovascular risk

In 1992, we advised that "the oral contraceptive of choice for a healthy young woman probably remains a combined preparation containing 30 or 35 micrograms oestrogen and one of the newer progestogens" (i.e. desogestrel, gestodene, norgestimate). In 1995, evidence emerged suggesting that combined oral contraceptives containing desogestrel or gestodene were associated with a risk of venous thromboembolism about twice that of pills containing other progestogens, and the Committee on Safety of Medicines (CSM) advised that desogestrel- and gestodene-containing pills should be used only by women who were intolerant of other combined oral contraceptives and prepared to accept an increased risk of venous thromboembolism. Following an appeal by the drug manufacturers to the UK Medicines Commission, this advice has been modified to state that, provided women are fully informed of the increased risks, "it should be a matter of clinical judgement and personal choice which type of oral contraceptive should be prescribed". Here, we discuss the evidence and events leading to the latest advice, reconsider our previous recommendations, and discuss other cardiovascular problems that may be associated with oral contraceptive pills.