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Different combined oral contraceptives and the risk of venous thrombosis: systematic review and network meta-analysis

BMJ 2013; 347 doi: https://doi.org/10.1136/bmj.f5298 (Published 12 September 2013) Cite this as: BMJ 2013;347:f5298

Re: Different combined oral contraceptives and the risk of venous thrombosis: systematic review and network meta-analysis

Numerous illnesses caused by oral contraceptives, not just venous thrombosis.

Once again those interested in clotting give pride of place to reducing the increase in venous thrombosis in recommending which combined oral contraceptives combinations “should” be prescribed.1 The reality is that it has been known since the 1960s that different doses and potency of progestogens vary the risk of bleeding,2 venous effects including thrombosis,3 weight gain,4 headaches and migraine,5 and depression and loss of libido.6 It also should not be forgotten that oral contraceptives were classified by IARC WHO as Group 1 carcinogens in 2007.7

There is also much evidence of increases in recent decades in serious health problems in women and their children caused by use of progestogens.8,9

1 Stegeman BH, de Bastos M, Rosendaal FR, et al. Different combined oral contraceptives and the risk of venous thrombosis: systematic review and network meta-analysis. BMJ 2013:347:f5298.

2 Grant ECG. Hormone balance of oral contraceptives. JObstetGynaecolBritComm 1967;74:908-18.

3 Grant ECG. Venous effects of oral contraceptives. BMJ 1969;2:73-7.

4 Changing oral contraceptives. BMJ 1969;4:789-91 & Today's Drugs.

5 Grant ECG. Relation between headaches from oral contraceptives and development of endometrial arterioles. BMJ 1968;3:402-5.

6 Grant ECG, Pryce Davies J. Effect of oral contraceptives on depressive mood changes and on endometrial monoamine oxidase and phosphatases. BMJ 1968;3:777-80.

7 IARC. Combined estrogen-progestogen contraceptives and combined estrogen-progestogen menopausal therapy. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans 2007; Volume 91.

8 Grant ECG. Re: Is an EMA review on hormonal contraception and thrombosis needed? BMJ (Published 13 April 2013).

9 Grant ECG. Re: Parental depression, maternal antidepressant use during pregnancy, and risk of autism spectrum disorders: population based case-control study. BMJ (Published 29 April 2013)

Competing interests: No competing interests

14 September 2013
Ellen CG Grant
Physician and medical gynaecologist
retired
Kingston-upon-Thames, KT2 7JU, UK