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VTE Risk with Combined Hormonal Contraceptives

Risk assessment of venous thromboembolism in combined oral contraceptive users.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Kadın Hastalıkları ve Doğum department. Book Appointment →

What is VTE Risk with Combined Hormonal Contraceptives?

Combined hormonal contraceptives (COC, vaginal ring, transdermal patch) increase the risk of venous thromboembolism (VTE) - deep vein thrombosis and pulmonary embolism - 2-6 fold compared with non-users. The absolute risk is approximately 2-12 per 10,000 women-years.

The risk varies according to oestrogen dose (≤30 µg ethinyl oestradiol is preferred), the type of progestin (3rd-4th generation progestins such as desogestrel, gestodene and drospirenone increase risk more than levonorgestrel-containing 2nd generation products), and route of administration (transdermal/vaginal carry slightly higher risk than oral).

Absolute contraindications include: active VTE, history of VTE, known thrombophilia (Factor V Leiden, prothrombin G20210A, antithrombin/protein C/S deficiency), antiphospholipid syndrome, smoking >35 years (>15 cigarettes/day), uncontrolled hypertension, complicated diabetes, migraine with aura, post-major surgery (within 4-6 weeks). Levonorgestrel-containing intrauterine systems or progestin-only options should be preferred in these groups.

Symptoms

Asymptomatic risk (latent)
Calf pain and swelling (DVT)
Sudden chest pain (PE)
Tachycardia, dyspnoea (PE)
Headache (rare CVST)
Visual disturbance
Sudden weakness

Risk Factors

Personal/family VTE history
Inherited thrombophilias
Antiphospholipid syndrome
Smoking (especially >35 years)
Obesity (BMI >30)
Long-term immobility (long-haul travel, post-surgery)
Postpartum period (first 6 weeks)
Cancer or chronic inflammatory disease

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Pre-prescription risk assessment
  • VTE history evaluation
  • Family thrombophilia history
  • Symptoms suspicious of VTE
  • Calf pain/swelling
  • Sudden dyspnoea or chest pain
  • Severe headache
  • Pre-elective surgery (4-6 weeks before)

Treatment Methods

01
Detailed personal and family history
02
Modified WHO MEC risk classification
03
Selection of low-oestrogen, levonorgestrel-containing pill
04
Risk-modification counselling (smoking cessation)
05
Switch to progestin-only methods
06
Long-acting LARC (IUD, implant) recommendation
07
Discontinuation 4-6 weeks before elective surgery
08
VTE work-up with relevant symptoms (D-dimer, US, CT)

Which Department to Visit?

You can visit our Kadın Hastalıkları ve Doğum department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

Learn About Kadın Hastalıkları ve Doğum Department

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.