Association of Venous Thromboembolism With Hormonal Contraception and Thrombophilic Genotypes

Bergendal, Annica; Persson, Ingemar; Odeberg, Jacob; Sundström, Anders; Holmström, Margareta; Schulman, Sam; Björgell, Ola; Kieler, Helle

doi:10.1097/aog.0000000000000411

Cited by 76 publications

(66 citation statements)

References 30 publications

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“…The use of low‐dose COCs containing cyproterone (nine studies, Fig. ), desogestrel (16 studies, Fig. ), drospirenone (10 studies,Fig.…”

Section: Resultsmentioning

confidence: 99%

“…Also excluded were articles that only reported the risk of VTE among a mixed group of COC users with different progestogen‐containing COCs (e.g., “third generation”), and articles where the reference group cited the use of COC with non‐specified progestogens . Five of the included studies did not clearly state the estrogen dose contained; one study spanning 1991 through 1995 relied on the UK Mediplus database, where the majority of recorded prescriptions were for low‐dose COC formulations, and the other four studies were conducted after 2000, when pills containing 50 μg ethinyl estradiol or more were uncommonly prescribed.…”

Section: Methodsmentioning

confidence: 99%

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

Dragoman

Tepper

et al. 2018

Intl J Gynecology & Obste

187

100

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BackgroundCombined oral contraceptives (COCs) containing various progestogens could be associated with differential risks for venous thromboembolism (VTE).ObjectiveTo evaluate the comparative risks of VTE associated with the use of low‐dose (less than 50 μg ethinyl estradiol) COCs containing different progestogens.Search strategyPubMed and the Cochrane Library were searched from database inception through September 15, 2016, by combining search terms for oral contraception and venous thrombosis.Selection criteriaStudies reporting VTE risk estimates among healthy users of progestogen‐containing low‐dose COCs were included.Data collection and analysisA 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 resultsThere 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.ConclusionsCompared 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.

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“…The use of low‐dose COCs containing cyproterone (nine studies, Fig. ), desogestrel (16 studies, Fig. ), drospirenone (10 studies,Fig.…”

Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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

Dragoman

Tepper

et al. 2018

Intl J Gynecology & Obste

187

100

View full text Add to dashboard Cite

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“…One of them suggested that the odds of VTE are higher among smokers using high-dose of progestin compared with smokers who did not use this hormonal treatment (27). Another study showed significantly elevated odds of VTE among women with factor V Leiden who used MPA comparing with non-use (28). Christiansen et al noted an elevated chance of recurrent VTE among women with a history of VTE using high-doses of progestin but that did not reach statistical significance (29).…”

Section: Discussionmentioning

confidence: 99%

Fertility Sparing Treatment in Patients With Early Stage Endometrial Cancer, Using a Combination of Surgery and GnRH Agonist: A Monocentric Retrospective Study and Review of the Literature

et al. 2018

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Objectives: To evaluate the efficacy and safety of gonadotropin-releasing hormone (GnRH) agonist after endometrial resection in women suffering early stage endometrial carcinoma (EC) and/or endometrial intra-epithelial neoplasia (EIN).Design: A retrospective review of clinical files between January 1999 and December 2016.Setting: University hospital.Patients: Eighteen women younger than 41 years with grade 1 endometrial carcinoma (G1EC) and/or Endometrial intra-epithelial neoplasia (EIN). Interventions: All patients received GnRH agonist for 3 months after an endometrial resection combined with a laparoscopy to exclude concomitant ovarian tumor and/or other extra-uterine disease. The patient underwent a follow-up of 3 months interval with endometrial sampling by hysteroscopy.Main Outcome Measure(s): The recurrence rate and the pregnancy rate after fertility sparing treatment.Results: We identified 9 patients with EIN (50%), 7 patients with G1EC (38.9%), 1 with combined histology (5.5%), and 1 with G2EC (5.5%). After a median follow-up of 40.7 months, 12 patients conserved their uterus (66.7%), and 8 (53.3%) patients were pregnant with a total of 14 pregnancies among those who tried to become pregnant. We observed a complete response rate in 12 patients (66.7%) but 3 of these patients relapsed (25%). We also found a stable disease in 6 patients (33.3%).Conclusions: Compared with other fertility sparing treatments, GnRH agonist after surgery is an effective fertility-sparing strategy for women with EIN and/or G1EC. We recommend hysterectomy once a family has been completed even if the literature does not clearly lead to radical surgery.

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“…Two studies (one cohort105 and one case-control250 study) did not find a statistically significant difference between CVR and EE/LNG COC users. The third (cohort) study245 reported an increased risk of VTE (RR 1.9; 95% CI 1.3–2.7) in women using the CVR compared to EE/LNG COC users.…”

Section: Health Risks Associated With Chc Usementioning

confidence: 89%

FSRH Guideline (January 2019, amended October 2023) Combined Hormonal Contraception

2019

BMJ Sex Reprod Health

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Association of Venous Thromboembolism With Hormonal Contraception and Thrombophilic Genotypes

Abstract: II.

Cited by 76 publications

References 30 publications

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

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

Fertility Sparing Treatment in Patients With Early Stage Endometrial Cancer, Using a Combination of Surgery and GnRH Agonist: A Monocentric Retrospective Study and Review of the Literature

FSRH Guideline (January 2019, amended October 2023) Combined Hormonal Contraception

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