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A recent study published in JAMA Network Open has found that certain progesterone-only hormonal contraceptives may carry a similar risk of venous thromboembolism (VTE) as some combined birth control pills. The findings shed new light on the potential dangers associated with different contraceptive methods.
Study Findings
A team of Dutch researchers analyzed the risk of blood clot formation associated with various types of synthetic progesterone and estrogen, including norgestimate, levonorgestrel, and desogestrel. The study also examined different contraceptive methods such as pills, vaginal rings, and patches. Among the most concerning results, the combined hormonal pill desogestrel and the progesterone-only medroxyprogesterone (Depo-Provera) injection were found to have the highest risk for blood clots.
Dr. Harman Gailan Hassan Yonis, a professor at Aalborg University Hospital in Denmark and the study’s lead researcher, emphasized that this study provides updated risk estimates for newer formulations, such as low-dose estrogen pills, vaginal rings, and implants, which had previously not been extensively studied in large population-based cohorts.
Research Methodology
The study examined health data from nearly 1.4 million women tracked in Danish national health registers over 8.4 million person-years. None of the participants had a prior history of thrombosis, cancer, liver or kidney disease, hormone therapy, or conditions such as polycystic ovary syndrome (PCOS) and endometriosis. Researchers adjusted for factors including age, education, and chronic illnesses like hypertension and diabetes to ensure accurate results.
During the study, 2,691 cases of VTE were recorded. Women who had never used hormonal contraceptives had a standardized VTE rate of 2.0 per 10,000 person-years. In comparison, combined hormonal pills showed rates as high as 10 per 10,000 person-years, while progesterone-only injections had a rate of 11.9 per 10,000 person-years. The lowest clot risk was associated with intrauterine devices, with a rate of 2.1 per 10,000 person-years.
Clinical Implications
Dr. Alexandria Wells, a clinical assistant professor of obstetrics and gynecology at Stony Brook Medicine, noted that while previous research had linked higher progesterone forms to blood clots, the discovery that progesterone-only injections posed a risk similar to combined pills was significant. She highlighted that additional factors, such as pre-existing conditions in patients prescribed progesterone-only methods, might contribute to the increased clot risk.
Yonis explained that women with conditions like PCOS and endometriosis were excluded from the study due to their use of additional hormonal treatments that could independently increase clot risk. He acknowledged that chronic inflammation and metabolic syndrome, both common in people with PCOS, also elevate the likelihood of developing blood clots.
Future Considerations
While the findings are unlikely to immediately alter prescribing guidelines, the study underscores the importance of personalized medical counseling. Dr. Wells emphasized that healthcare providers can use this information to guide patients in selecting the most suitable contraceptive option based on their risk factors.
Dr. Yonis also pointed out a key limitation of the study: the participants were predominantly White and Dutch. He noted that blood clot risks might vary among different ethnic groups due to genetic, environmental, and lifestyle factors. This suggests the need for further research to assess the impact on diverse populations, including women in the United States, who often have higher rates of comorbidities.
Funding and Conflicts of Interest
The study was funded by Sygeforsikringen “Danmark.” Dr. Yonis disclosed receiving grant funding from TrygFonden and Laerdal, while other study authors reported personal fees and grants from pharmaceutical companies such as Pfizer and Novo Nordisk.
Disclaimer
This article is for informational purposes only and should not be used as a substitute for professional medical advice. Individuals should consult their healthcare providers before making any decisions regarding contraceptive use.
