Thrombotic risks of oral contraceptives

Purpose of review To inform about the risk of venous thromboembolism (VTE) of different hormonal contraceptives in different patient groups. Recent findings Combined oral contraceptives (COCs) differ significantly regarding VTE risk depending on amount of estrogen and type of progestogen: COCs containing desogestrol, gestoden or drospirenone in combination with ethinylestradiol (so called third-generation or fourth-generation COCs) are associated with a higher VTE risk than COCs with ethinylestradiol and levonorgestrel or norethisterone (so called second-generation COCs). The VTE risk for transdermal COCs like vaginal ring (NuvaRing) or patch (Evra) is as high as for COCs of third or fourth generation. Progestogen-only contraceptive methods do not increase VTE risk significantly. New kinds of COC without ethinylestradiol but with estradiol valerat or estradiol showed a much lower degree of coagulation activation than 'classical' COC containing ethinylestradiol. Summary Second-generation COCs should be the first choice when prescribing hormonal contraception. In patients with a history of VTE and/or a known thrombophilic defect, COCs are contraindicated, but progestogen-only contraceptives can be safely used in this patient group. Whether newer COCs with estradiol valerate or estradiol have a lower VTE risk remains to be elucidated.