Venous thromboembolism in women taking hormonal contraceptives.
Hormonal contraceptives are a popular method of contraception, but their use has been associated with an increased risk for venous thromboembolism. In order to reduce such risk, these compounds have been changed in their dosage, chemical composition and route of administration. The absolute risk of death from pulmonary embolism in contraceptive users has been estimated to be 10.5 (95% CI: 6.2-16.6) per million woman-years. The safest option is an oral contraceptive containing levonorgestrel combined with a low dose of estrogen. Identifying women at increased risk for venous thromboembolism is difficult, and greater use of thromboprophylaxis during immobility or minor surgery should be warranted. Several authors have called for all women to be screened for thrombophilia before prescription of hormonal contraceptives, but its cost-effectiveness remains uncertain.
Department of Internal Medicine, Hospital Universitario Reina Sofía, Córdoba, Spain. mablancom@telefonica.net
Angeles
A
Blanco-Molina
Manuel
M
Monreal
D003277:Contraceptives, Oral, Combined / Q000009:adverse effects; D003278:Contraceptives, Oral, Hormonal / Q000009:adverse effects* / Q000627:therapeutic use; D004967:Estrogens / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D006801:Humans; D007103:Immobilization / Q000009:adverse effects; D015994:Incidence; D016912:Levonorgestrel / Q000009:adverse effects; D008403:Mass Screening / Q000191:economics; D011655:Pulmonary Embolism / Q000139:chemically induced / Q000453:epidemiology / Q000401:mortality; D018570:Risk Assessment; D019851:Thrombophilia / Q000175:diagnosis; D054556:Venous Thromboembolism / Q000139:chemically induced / Q000453:epidemiology*
D003277:Contraceptives, Oral, Combined; D003278:Contraceptives, Oral, Hormonal; D004967:Estrogens; D016912:Levonorgestrel