Progestogen content of oral contraceptives singled out in VTE
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Progestogen content of oral contraceptives singled out in VTE According to a Danish study published in the BMJ, women using combined oral contraceptives (COCs) containing levonorgestrel have a threefold increased risk of experiencing venous thromboembolism (VTE), compared with non-users of hormonal contraception, while those using contraceptives containing desogestrel, gestodene or drospirenone have a six- to seven-fold increased risk.1 It is "unlikely that these findings could be explained by bias or confounding", say the study’s authors. The national historical cohort study analysed data obtained from four registries in Denmark for nonpregnant women aged 15–49 years with no history of thrombotic disease, who were followed from January 2001 to December 2009. Within over 8 million women-years of observation, 4307 first ever VTE events were recorded, of which 2847 were confirmed as certain. When compared with nonusers of hormonal contraception, women who used COCs containing ethinylestradiol 30–40µg combined with levonorgestrel had a relative risk of VTE of 2.9 (95% CI 2.2, 3.8). The relative risk of VTE associated with desogestrel-containing pills was 6.6 (5.6, 7.8), while for gestodene it was 6.2 (5.6, 7.0), and for drospirenone 6.4 (5.4, 7.5). The risk of confirmed VTE was not raised by the use of progestogen-only pills or hormone-releasing intrauterine devices, note the authors.
Don’t exaggerate the risk, says Professor In an editorial accompanying the study, Professor Philip C Hannaford from the University of Aberdeen, Scotland, writes that, "although unpalatable to some, it is difficult not to conclude that combined oral contraceptives with desogestrel, gestodene, or drospirenone confer a higher risk of venous thromboembolism than those with levonorgestrel".2 Professor Hannaford suggests that many clinicians will seek to minimise this risk by prescribing a COC containing levonorgestrel "whenever possible". However, he also contends that it is "crucial" not to exaggerate the risk, and states that COCs are "remarkably safe and may confer important long term benefits in relation to cancer and mortality". See also this issue p1; 803062265 1. Lidegaard Ø, et al. Risk of venous thromboembolism from use of oral contraceptives containing different progestogens and oestrogen doses: Danish cohort study, 2001-9 BMJ 343: [15 pages], 25 Oct 2011. Available from: URL: http://dx.doi.org/10.1136/bmj.d6423. 2. Hannaford PC. The progestogen content of combined oral contraceptives and venous thromboembolic risk. BMJ 343: [2 pages], 25 Oct 2011. Available from: URL: http://dx.doi.org/10.1136/bmj.d6592. 801157978
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Reactions 5 Nov 2011 No. 1376
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