Third generation oral contraceptivesBMJ 2000; 321 doi: https://doi.org/10.1136/bmj.321.7255.190 (Published 22 July 2000) Cite this as: BMJ 2000;321:190
Caution is still justified
- David C G Skegg, professor
- Department of Preventive and Social Medicine, University of Otago, PO Box 913, Dunedin, New Zealand
Oral contraception is effective, convenient, and reversible. For most women it is also remarkably safe. Some people involved in family planning go further and imply that the oral contraceptive pill is almost free of risk. This creates an illusion that is shattered whenever adverse effects—however rare—are brought to light. In October 1995 the Committee on Safety of Medicines in the United Kingdom warned that oral contraceptives containing desogestrel or gestodene carried a small increase in risk of venous thromboembolism compared with older preparations. The chaos that followed in Britain (and a few other countries) may have stemmed partly from an illusion of absolute safety, as well as from the publicity triggered by the warning.
The committee's announcement was followed by the publication of four well designed studies that gave a consistent picture: women using third generation oral contraceptives containing desogestrel or gestodene had about twice the risk of venous thromboembolism of women using preparations containing levonorgestrel.1 In the four years that have followed, a plethora of articles, reviews, and symposiums have implied that these reports were flawed and that reanalyses or new studies show no differences in the risk of …