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Int J Gynaecol Obstet. 2018 Jun;141(3):287-294. doi: 10.1002/ijgo.12455. Epub 2018 Feb 22.

A systematic review and meta-analysis of venous thrombosis risk among users of combined oral contraception.

Author information

1
Department of Reproductive Health and Research, WHO, Geneva, Switzerland.
2
Division of Reproductive Health, US Centers for Disease Control and Prevention, Atlanta, GA, USA.
3
Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, OR, USA.

Abstract

BACKGROUND:

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.

SEARCH STRATEGY:

PubMed and the Cochrane Library were searched from database inception through September 15, 2016, by combining search terms for oral contraception and venous thrombosis.

SELECTION CRITERIA:

Studies reporting VTE risk estimates among healthy users of progestogen-containing low-dose COCs were included.

DATA COLLECTION AND ANALYSIS:

A 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 RESULTS:

There 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.

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.

KEYWORDS:

Combined oral contraceptives; Hormonal contraception; Meta-analysis; Risk; Systematic review; Venous thromboembolism

PMID:
29388678
PMCID:
PMC5969307
DOI:
10.1002/ijgo.12455
[Indexed for MEDLINE]
Free PMC Article

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