Statement on combined hormonal contraceptives containing third- or fourth-generation progestogens or cyproterone acetate, and the associated risk of thromboembolism

The bitter pill

“…The discrepancy has led to heated scientific debate about design flaws, possible confounders and biases in the studies 7 8. Furthermore, some experts have questioned the biological plausibility of the anti-estrogenic effect of older progestogens.…”

“…Scientific evidence doesn't always give absolute answers and experts don't always agree 7. Pending lawsuits involving huge amounts of money create an environment where scientists are under pressure to present indisputable evidence.…”

Comment on ‘Statement on combined hormonal contraceptives containing third- or fourth-generation progestogens or cyproterone acetate, and the associated risk of thromboembolism’: author's response

“…Following this statement Drs Terplan and Zuckerman argue that the public health conclusion has to be that the use of the newer preparations has to be limited to special indications and that the older preparations provide health care professionals and women with enough possibilities to protect women against unwanted pregnancies. Drs Terplan and Zuckerman argue that due to the fact that millions of women take COCs it is a public health duty to establish this policy of prescription to save many women’s lives, and that statements like ours are based primarily on opinion rather than scientific facts and that the authors of the statement2 are very likely driven by interests related to pharmaceutical companies leading them to “hostile behaviour towards physicians who are driven by evidence and concern for women” (assuming that the authors of the statement are not interested in evidence nor have concerns for women).…”

“…I would like to thank Drs Terplan and Zuckerman for their comments1 on the recently published position statement,2 which myself and the other cosignatory authors take very seriously.…”

Comment on ‘Statement on combined hormonal contraceptives containing third- or fourth-generation progestogens or cyproterone acetate, and the associated risk of thromboembolism’

“…While we agree that the importance of effective and well-tolerated contraceptives is indisputable, we must ask for evidence that questioning the safety of newer-generation progestogens compared to older formulations has caused a “new pill scare”, or a “crisis” resulting in a “highly emotional political dimension” 1. The implication that ideology or overreaction rather than scientific analysis underlies the numerous recent calls for increased scrutiny and changes in prescribing practice, and that patients are being harmed as a result, deserves a serious response.…”