title: Hormonal contraception, thrombosis and age.
abstract: BACKGROUND
  This paper reviews the risk of thrombosis with use of different types of hormonal contraception in women of different ages.
  
  
  METHODS
  Combined hormonal contraceptives with desogestrel, gestodene, drospirenone or cyproterone acetate (high-risk products) confer a sixfold increased risk of venous thromboembolism as compared with nonusers, and about twice the risk as compared with users of products with norethisterone, levonorgestrel or norgestimate (low-risk products). Transdermal patches and vaginal ring belong to high-risk products. The risk of thrombotic stroke and myocardial infarction is increased 50 - 100% with use of combined products, with little difference in risk between different progestins. Progestin-only products do not confer any increased risk of venous or arterial thrombosis, except for progestin depot, which may double the risk of venous thrombosis.
  
  
  CONCLUSIONS
  First choice in women below 35 years should be a combined low-risk pill, that is, with a second-generation progestin, with the lowest compliable dose of estrogen. Young women with risk factors of thrombosis such as age above 35 years, genetic predispositions, adiposity, polycystic ovary syndrome, diabetes, smoking, hypertension or migraine with aura should not use high-risk products, but should primarily consider progestin-only products, and be careful to use low-risk combined products.
authors.affiliation: University of Copenhagen, Department of Obstetrics and Gynecology, Faculty of Health Science, 4232, Rigshospitalet , Copenhagen 2100 , Denmark Oejvind.Lidegaard@regionh.dk.
authors.forename: Øjvind
authors.initials: Ø
authors.lastname: Lidegaard
mesh_terms: D000328:Adult; D000367:Age Factors; D003277:Contraceptives, Oral, Combined / Q000008:administration & dosage / Q000009:adverse effects*; D003278:Contraceptives, Oral, Hormonal / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D020022:Genetic Predisposition to Disease; D006801:Humans; D009203:Myocardial Infarction / Q000139:chemically induced / Q000453:epidemiology; D011372:Progestins / Q000008:administration & dosage / Q000009:adverse effects; D012307:Risk Factors; D020521:Stroke / Q000139:chemically induced / Q000453:epidemiology; D013927:Thrombosis / Q000139:chemically induced* / Q000453:epidemiology / Q000503:physiopathology
chemical_list: D003277:Contraceptives, Oral, Combined; D003278:Contraceptives, Oral, Hormonal; D011372:Progestins
keywords: age; hormonal contraception; oral contraceptives; thrombosis; venous thrombosis