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Hormonal contraception and venous thromboembolism
Øjvind Lidegaard1, Ian Milsom, Reynir Tomas Geirsson
1Gynaecological Clinic 4232, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. lidegaard@dadlnet.dk
Acta Obstetricia Et Gynecologica Scandinavica
|May 10, 2012
Summary
Newer hormonal contraceptives, particularly those with newer progestogens, increase venous thromboembolism (VTE) risk. Switching to older progestogen combined oral contraceptives (COCs) or progestogen-only methods can reduce this risk.
Area of Science:
- Reproductive Health
- Pharmacovigilance
- Epidemiology
Background:
- Recent studies indicate a link between hormonal contraception and venous thromboembolism (VTE) risk.
- Understanding these associations is crucial for public health and clinical practice.
Purpose of the Study:
- To evaluate current epidemiological data on hormonal contraception and VTE risk.
- To provide clinical recommendations based on the latest evidence.
Main Methods:
- A comprehensive literature survey was conducted.
- Epidemiological studies on various hormonal contraceptive types and VTE risk were analyzed and compared.
Main Results:
- Combined oral contraceptives (COCs) with newer progestogens (desogestrel, gestodene, drospirenone, cyproterone acetate) or vaginal rings showed a sixfold VTE risk increase.
- COCs with older progestogens (norethisterone, levonorgestrel, norgestimate) demonstrated a threefold VTE risk increase.
- Progestogen-only contraception was not associated with an increased VTE risk.
Conclusions:
- First-choice hormonal contraception should be medium- or low-dose COCs with norethisterone, levonorgestrel (LNG), or norgestimate.
- Women using COCs with newer progestogens may halve their VTE risk by switching to formulations with older progestogens.
- Progestogen-only or non-hormonal contraception is recommended for women at increased VTE risk.
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