contraceptives--postcoital and Venous-Thrombosis

Recent advances in OCPs include less androgenic progestins and lower doses of ethinyl estradiol. All low-dose OCPs are safe in terms of venous thrombosis risk in appropriately chosen patients. DMPA is a safe and effective long-acting contraceptive agent; clinical attention should be directed to its most common side effect, irregular bleeding. DMPA does not seem to affect mood, and it is uncertain what impact it has on weight changes. More research needs to be conducted on its impact on adolescent bone metabolism. Norplant continues to be the only subdermal contraceptive implant marketed in the United States. It provides safe and effective contraception and has the best continuation rate of all types of hormonal contraception. Its most common side effect is irregular bleeding. Norplant may be especially well suited for adolescents who have recently been pregnant or who are not tolerating other types of contraception. Emergency postcoital contraception continues to be underused in the United States, with a lack of awareness among patients and clinicians. Mechanisms of action include a delay in ovulation and interference with implantation. Research and public health groups are striving to increase patient and provider awareness and use of emergency contraception.

Topics: Adolescent; Adolescent Behavior; Adult; Contraception; Contraceptive Agents, Female; Contraceptives, Oral; Contraceptives, Postcoital; Drug Implants; Female; Humans; Medroxyprogesterone Acetate; Pregnancy; Venous Thrombosis

Topics: Contraceptives, Postcoital; Dose-Response Relationship, Drug; Female; Humans; Magnetic Resonance Angiography; Middle Aged; Portal Vein; Progesterone; Progestins; Tomography, X-Ray Computed; Venous Thrombosis

Postcoital contraceptive pills (PCP) have recently been approved for use as emergency contraception in the United States. The objective of this study was to assess the risk of idiopathic venous thromboembolism (VTE) in relation to exposure to PCP, and to better quantify the risk of idiopathic VTE associated with current oral contraceptive (OC) use and pregnancy. A population-based cohort study with a nested case-control analysis was conducted using women from the General Practice Research Database. There were no women with an outcome of idiopathic VTE with current exposure to PCP. The incidence rates for various exposures were 3.0/100,000 person-years for the unexposed, 5.3/100,000 person-years for second generation OC, 10.7/100,000 person-years for third generation OC, and 15.5/100,000 person-years in pregnant (or postpartum) women. The relative risk estimates were 1.7 (95% CI 0.3-10.5) for second generation OC, 4.4 (95% CI 1.0-18.7) for third generation OC, and 6.3 (95% CI 1.2-33.5) for pregnancy. Short-term use of PCP is not associated with a substantially increased risk for developing VTE.. A population-based cohort study with a nested case-control analysis was conducted to assess the risk of idiopathic venous thromboembolism (VTE) in relation to exposure to postcoital contraceptive pills (PCP) and to better quantify the risk of idiopathic VTE associated with current oral contraceptive (OC) use and pregnancy. The subjects were women less than 50 years of age who received PCP prescriptions at some time between January 1, 1989, and October 31, 1996. All subjects in the cohort of PCP users had a computer-recorded diagnosis from the General Practice Research Database. The results of the study indicate that there were no women currently exposed to PCP who had an outcome of idiopathic VTE. The incidence rates for various exposures were 3.0/100,000 person-years for those unexposed, 5.3/100,000 person-years for second-generation OCs, 10.7/100,000 person-years for third-generation OCs, and 15.5/100,000 person-years for pregnant (or postpartum) women. The relative risk estimates were 1.7 (95% CI, 0.3-10.5) for second-generation OCs and 4.4 (95% CI, 1.2-33.5) for pregnancy. Thus, the risk of VTE attributable to PCP is not substantially higher than it is for the risk for traditional OCs, despite the higher content of both estrogen and progesterone present in PCP.

Topics: Adult; Age Factors; Case-Control Studies; Cohort Studies; Contraceptives, Postcoital; Databases as Topic; Family Practice; Female; Humans; Middle Aged; Pregnancy; Risk; Risk Assessment; Smoking; Thromboembolism; United Kingdom; United States; Venous Thrombosis