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Endocrine Abstracts (2014) 35 S15.1 | DOI: 10.1530/endoabs.35.S15.1

ECE2014 Symposia Thromboembolism and contraception (3 abstracts)

Epidemiology of sex steroid-related thromboembolism

Genevieve Plu-Bureau 1, , Justine Hugon-Rodin 1, & Anne Gompel 1


1Department of Gynecology and Endocrinology, Hôpital Universitaires Paris Centre, Paris-Descartes University, Paris, France; 2Hormones and Cardiovascular Disease, CESP, U1018, Inserm,, Villejuif, France.


Venous thrombosis is a common disease, with an annual incidence of 1–4/1000 persons. Before menopause its incidence is low and strongly increases with age. Combined hormonal contraceptives (COC) increased the risk of VTE. COC use explains a substantial part of VTE among childbearing-aged women and VTE is the most important determinant of the benefit/risk profile of hormonal contraceptive. The increase in thrombotic risk is the highest the first year of COC use and third generation pill use (desogestrel or gestodène) is associated with an increased VTE risk as compared to second generation (levonorgestrel) pill use (OR: 1.7 95% CI 1.4-2.0). Specific molecules combined with ethinyl-estradiol (EE) such as drospirenone or cyproterone acetate have been now investigated. Most of the studies have reported a significant increased VTE risk among users of these COC when compared with non user or with users of second generation pill. Two new pills deliver estradiol combined with either nomegestrol acetate or dienogest. No published epidemiological data on the risk of VTE are yet available. Non oral combined contraceptives methods are also available such as the combined EEl/norelgestomin transdermal patch and the EE/etonogestrel vaginal ring. These route of EE administration seem to be more thrombogenic than second generation pill. These results are in agreement with biological data. Overall, the estrogenic climate of each contraceptive pill, depending on both EE doses and progestin molecule, could reflect the level of thrombotic risk.

Progestin-only contraceptive is an alternative for women with contraindication of estrogen use. By contrast with COC, low doses of both oral progestin contraceptives and intra-uterine levonorgestrel could be safe with respect to VTE risk.

In conclusion, newer generation formulations of hormonal contraceptives as well as the non-oral hormonal contraceptive seem to be more thrombogenic than second generation hormonal contraceptives.

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