Progestogen-Only Methods do not Elevate the Risk of Cardiovascular Disease

Abstract

The World Health Organization Collaborative Study of Cardiovascular Disease and Steroid Hormonal Contraception found no evidence of increased cardiovascular risk in women who used oral or injectable progestogen-only contraceptive methods. The analyses were based on 3697 women with cardiovascular disease from 21 centers in 17 countries in Africa Asia Europe and Latin America. Women with a history of hypertension were at increased risk of stroke regardless of their use of a hormonal contraceptive but this pattern did not apply to venous thromboembolism or heart attack. Use of progestogen-only methods was associated with small but nonsignificant increases in cardiovascular risk among smokers. Many of the risk estimates in this study had wide confidence intervals because of the small numbers of users of progestogen-only methods enrolled at the various study centers. The interaction between progestogen-only contraceptives and hypertension merits further assessment especially because women with a history of high blood pressure use progestogen-only pills more frequently than combined oral contraceptives.