Abstract
BackgroundCombined oral contraceptives (COCs) containing various progestogens could be associated with differential risks for venous thromboembolism (VTE).ObjectiveTo evaluate the comparative risks of VTE associated with the use of low‐dose (less than 50 μg ethinyl estradiol) COCs containing different progestogens.Search strategyPubMed and the Cochrane Library were searched from database inception through September 15, 2016, by combining search terms for oral contraception and venous thrombosis.Selection criteriaStudies reporting VTE risk estimates among healthy users of progestogen‐containing low‐dose COCs were included.Data collection and analysisA random‐effects model was used to generate pooled adjusted risk ratios and 95% confidence intervals; subgroup and sensitivity analyses assessed the impact of monophasic‐COC use and study‐level characteristics.Main resultsThere were 22 articles included in the analysis. The use of COCs containing cyproterone acetate, desogestrel, drospirenone, or gestodene was associated with a significantly increased risk of VTE compared with the use of levonorgestrel‐containing COCs (pooled risk ratios 1.5–2.0). The analysis restricted to monophasic COC formulations with 30 μg of ethinyl estradiol yielded similar findings. After adjustment for study characteristics, the risk estimates were slightly attenuated.ConclusionsCompared with the use of levonorgestrel‐containing COCs, the use of COCs containing other progestogens could be associated with a small increase in risk for VTE.
Highlights
Venous thromboembolism (VTE) is rare among healthy women of reproductive age, combined oral contraceptive (COC) use can increase the risk for venous thromboembolism (VTE), including deep venous thrombosis and pulmonary embolism, compared with nonuse.[1,2] the incidence of VTE remains low (8–10 events per 10 000 women-years of exposure) among COC users, andInt J Gynecol Obstet 2018; 141: 287–294 288 |is much lower than the incidence of VTE during pregnancy and the postpartum period.[3,4] The effect of COCs on the risk of thrombosis was traditionally thought to be solely related to the effects of estrogen on hemostatic factors
In the present systematic review and meta-analysis, PubMed and the Cochrane Library databases were searched for all articles on the association between COC use and VTE in all languages published from database inception through September 15, 2016, using a combination of search terms for oral contraception and venous thrombosis (Table S1)
The present meta-analysis indicated that the use of low-dose COCs containing cyproterone acetate, desogestrel, dienogest, drospirenone, or gestodene was associated with an increased risk of VTE compared with the use of levonorgestrel-containing COCs, the difference was not statistically significant for dienogest
Summary
Venous thromboembolism (VTE) is rare among healthy women of reproductive age (incidence 5–10 events per 10 000 women-years), combined oral contraceptive (COC) use can increase the risk for VTE, including deep venous thrombosis and pulmonary embolism, compared with nonuse.[1,2] the incidence of VTE remains low (8–10 events per 10 000 women-years of exposure) among COC users, andInt J Gynecol Obstet 2018; 141: 287–294 288 |is much lower than the incidence of VTE during pregnancy and the postpartum period.[3,4] The effect of COCs on the risk of thrombosis was traditionally thought to be solely related to the effects of estrogen on hemostatic factors. Venous thromboembolism (VTE) is rare among healthy women of reproductive age (incidence 5–10 events per 10 000 women-years), combined oral contraceptive (COC) use can increase the risk for VTE, including deep venous thrombosis and pulmonary embolism, compared with nonuse.[1,2]. The objective of the present systematic review and meta-analysis was to estimate the risk for VTE among women using COCs containing different progestogens compared with COCs containing levonorgestrel. Combined oral contraceptives (COCs) containing various progestogens could be associated with differential risks for venous thromboembolism (VTE). Objective: To evaluate the comparative risks of VTE associated with the use of low- dose (less than 50 μg ethinyl estradiol) COCs containing different progestogens. Selection criteria: Studies reporting VTE risk estimates among healthy users of progestogen-containing low-dose COCs were included. Conclusions: Compared with the use of levonorgestrel-containing COCs, the use of COCs containing other progestogens could be associated with a small increase in risk for VTE
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