Hormonal contraception in women at risk of vascular and metabolic disorders: guidelines of the French Society of Endocrinology.
Hormonal contraceptive methods are widely used in France, including not only oral estrogen-progestin combinations but also non-oral estrogen-progestin delivery methods (patches, vaginal rings), as well as oral forms, implants and intra-uterine devices that deliver only a progestin. Hormonal contraception has only a modest impact on lipid and carbohydrate metabolism, but estrogen-progestin contraceptives have been linked to a variety of vascular risks. Overall, the risk of venous thrombosis is multiplied by a factor of about 4, depending on age, the compounds used, and other risk factors (including biological thrombophilia and a personal history of thrombosis), whereas the risk of arterial events is only increased in women with risk factors. Available data suggest there is no excess risk with progestin-based contraceptives, but far fewer studies have been conducted. At the initiative of the French Society of Endocrinology, an expert group met in 2010 in order to reach a consensus on the use of hormonal contraceptive methods in women with vascular or metabolic risk factors, based on available data and international guidelines published by WHO in 2009 and subsequently adapted to the United States context. The following text, intentionally limited to hormonal contraception, is intended to serve as a guide when prescribing in specific clinical situations, such as a family or personal history of arterial or venous thromboembolism, or the existence of cardiovascular risk factors (hypertension, smoking, diabetes, dyslipidemia, obesity).
Service de diabétologie, maladies métaboliques et nutrition, CHU de Toulouse, Inserm U1048, institut des maladies métaboliques et cardiovasculaires, 31059 Toulouse, France. pierre.gourdy@inserm.fr
Pierre
P
Gourdy
Anne
A
Bachelot
Sophie
S
Catteau-Jonard
Nathalie
N
Chabbert-Buffet
Sophie
S
Christin-Maître
Jacqueline
J
Conard
Alexandre
A
Fredenrich
Anne
A
Gompel
Françoise
F
Lamiche-Lorenzini
Caroline
C
Moreau
Geneviève
G
Plu-Bureau
Anne
A
Vambergue
Bruno
B
Vergès
Véronique
V
Kerlan
D002318:Cardiovascular Diseases / Q000139:chemically induced; D003267:Contraception / Q000639:trends; D003271:Contraceptive Agents, Female / Q000008:administration & dosage / Q000009:adverse effects*; D003278:Contraceptives, Oral, Hormonal / Q000009:adverse effects*; D003920:Diabetes Mellitus; D004704:Endocrinology; D004967:Estrogens / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D005602:France; D006801:Humans; D006949:Hyperlipidemias; D050356:Lipid Metabolism / Q000187:drug effects; D008659:Metabolic Diseases / Q000139:chemically induced; D009765:Obesity; D011247:Pregnancy; D011372:Progestins / Q000008:administration & dosage / Q000009:adverse effects; D012307:Risk Factors; D012955:Societies, Medical; D013923:Thromboembolism / Q000139:chemically induced
D003271:Contraceptive Agents, Female; D003278:Contraceptives, Oral, Hormonal; D004967:Estrogens; D011372:Progestins