JAMA

VTE risk varies by hormonal contraception type and dose

February 12, 2025

Study details: A nationwide cohort study in Denmark examined VTE risk among 1,397,235 females aged 15 to 49 years using various hormonal contraceptives from January 1, 2011, to July 1, 2021. Exclusion criteria included history of thrombosis, cancer, and other significant health conditions. Hormonal contraceptive use was tracked through prescription records, and VTE events were identified via national health registers.

Results: Combined hormonal contraceptives, particularly those containing third-generation progestins,* were associated with the highest VTE risk. Standardized VTE rates per 10,000 person-years ranged from 11.9 (95% confidence interval [CI], 4.4-25.6) for injections to 2.0 (95% CI, 1.9-2.1) for nonuse, a rate similar to that of IUDs (95% CI, 1.7-2.6). VTE excess per 10,000 person-years ranged from 3.0 (95% CI, -1.8 to 7.7) for 20-μg estrogen pills with levonorgestrel to 14.2 (95% CI, 9.2 to 19.3) for combined pills with third-generation progestins. Pills with bioidentical estradiol also showed increased rates.

Clinical impact: Clinicians should consider the varying VTE risks associated with different hormonal contraceptives and weigh these risks when advising patients on contraceptive options, particularly for those with predisposing factors for VTE.

*Examples of third-generation progestins include desogestrel and norgestimate.

Source:

Yonis HGH, et al. (2025, February 10). JAMA. Contemporary Hormonal Contraception and Risk of Venous Thromboembolism. https://pubmed.ncbi.nlm.nih.gov/39928320/