Hormonal contraception in thrombophilic adolescents

Summary

About 3.2 million women in Germany are between 14 and 19 years old representing about 19% of women. 55% of them use combined oral contraception (COC). The risk of venous thromboembolism (VTE) during the use of COC is increased 2–6 times. For thrombophilic patients depending on the kind of thrombophilic defect it is much higher. Pregnancy and postpartum period lead to a much higher increase of VTE than any COC use at all, both in women with and without thrombophilic defect. VTE risk in COC is highly dependent on the content of ethinylestradiol (EE) and the kind of progestagen used in COC. Progestagen-only contraceptives (POC) do not increase the VTE risk, since they do not activate the coagulation system. Conclusion: It is not justified to withhold any hormonal contraception to thrombophilic women, especially considering the much higher VTE risk in (maybe unintended) pregnancy. Adolescents thrombophilic women should rather be informed about the opportunity to use POC.

Zusammenfassung

Ungefähr 3,2 Millionen Frauen in Deutschland sind zwischen 14 und 19 Jahre alt, dies entspricht ca. 19% der Frauen. 55% von ihnen verwenden kombinierte orale Kontrazeptiva (KOK). Das Risiko für venöse thromboembolische Erkrankungen (VTE) während der Einnahme von KOK ist ca. 2- bis 6-fach erhöht. Für thrombophile Patientinnen ist das Risiko je nach Schweregrad der Thrombophilie deutlich höher. Schwangerschaft und Wochenbett sind allerdings mit einem deutlich höheren Risiko für VTE verbunden im Vergleich zur KOK-Einnahme, sowohl bei Frauen mit wie auch ohne thrombophilen Defekt. KOK unterscheiden sich im VTE-Risiko je nach der Art des enthaltenen Gestagen-Anteils und der Östrogendosis. Reine gestagenhaltige Verhütungsmittel, z. B. rein gestagenhaltige Pillen, erhöhen dagegen das Thrombosrisiko nicht, da Gestagene nicht zur Gerinnungsaktivierung führen. Schlussfolgerung: Es ist also nicht gerechtfertigt, thrombophilen Patientinnen generell eine hormonelle Kontrazeption zu verweigern, insbesondere im Hinblick auf das deutlich hö-here VTE-Risiko im Rahmen einer evtl., ggf. auch ungewollten, Schwangerschaft. Vielmehr sollte auf die Möglichkeit der rein gesta-genhaltigen Kontrazeption aufmerksam gemacht werden v. a. bei adoleszenten Frauen.

Keywords

Thrombophilia - contraception - adolescents - COC - progestagen only pills

Schlüsselwörter

Thrombophilie - Kontrazeption - Jugendliche - KOK - Gestagenpillen

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