Contraception and venous thromboembolism

Summary

In Germany approximately 20 million women are in their reproductive age. One third of them are taking combined oral contraceptives (COC), which consists mostly of Ethinylestradiol (EE) and a synthetic gestagen. Basic risk for venous thromboembolism (VTE) in women of this age is low, but rises during pregnancy or when combined hormonal contraceptives (CHC) are used. Therefore, women have a higher risk than men for VTE until the age of 35, after that time point the risk remains equal. Elevation of the thrombotic risk depends on the selected contraceptive. Older COC with norgestimat or levonorgestrel have a lower risk than newer COC. This is also true for nonoral KHK. Consequently, these older COC are the first choice in many international guidelines. Newer generations of contraceptives should only be prescribed, if a secondary reason other than contraception exists. The risk of newer COC containing Estradiol and not Ethinylestradiol instead of EE is not clear due to missing data. The use of gestagen only hormonal contraception with does not contain any significant increase of the risk for VTE with the exception of depot depot medroxyprogesterone acetate (DMPA). Emergency contraception, which do not contain ee, but only contains Levonorgestrel or Ulipristalacetat does not result in a higher risk for VTE. Oral desogestrel or levonorgestrel only contraceptives, intrauterine device (IUD) and Etonogestrel implants are the contraception of choice in women with a history of VTE or suffering from thrombophilia. These safe contraceptives should be offered to women with high risk of VTE due to the much higher VTE risk in pregnancy. The screening for thrombophilia is not indicated in every woman with the wish for contraception. This should be restricted to certain cases, e. g. to women with a positive history for VTE or with close relatives suffering from VTE in young age under 50 years.

Keywords

Venous thromboembolism (VTE) - thrombosis - combined contraception - gestagen - gestagenonly contraception - emergency contraception - pregnancy

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