[Hormonal contraception and venous thromboembolism].

Area of Science:

• Reproductive Medicine
• Thrombosis Research
• Pharmacology

Background:

• Combined hormonal contraceptives (CHC) are linked to increased venous thromboembolism (VTE) risk.
• VTE risk associated with CHC varies based on estrogen and progestin components.
• Progestin-only contraceptives, excluding depot medroxyprogesterone acetate, generally do not pose a significant VTE risk.

Purpose of the Study:

• To review the VTE risks associated with different contraceptive types.
• To provide guidance on contraceptive choices for women with thrombophilia or VTE history.
• To inform clinical practice regarding CHC use during anticoagulation and post-VTE management.

Main Methods:

• Literature review of studies on contraceptive use and VTE.
• Analysis of current guidelines, including the German S3 guideline "Contraception".
• Evaluation of evidence regarding VTE risk during oral anticoagulation and hormone-associated VTE recurrence.

Main Results:

• VTE risk is dependent on specific estrogen-progestin combinations in CHCs.
• Progestin-only contraceptives are suitable for women with thrombophilia or prior VTE.
• No evidence indicates increased VTE risk during oral anticoagulation with CHC, with specific timing recommendations for switching to estrogen-free contraception.
• Recurrence risk after hormone-associated VTE is low, with anticoagulation typically discontinued after 3-6 months.
• Low molecular weight heparin is recommended for thromboprophylaxis in pregnant/postpartum women with prior hormone-associated VTE.

Conclusions:

• Individual VTE risk assessment is crucial before prescribing CHC.
• Estrogen-free contraceptives are recommended for women with thrombophilia or VTE history.
• CHC can be used cautiously during anticoagulation, with a planned transition to estrogen-free methods.
• Management of hormone-associated VTE involves short-term anticoagulation and appropriate thromboprophylaxis during pregnancy/postpartum periods.