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Superficial thrombophlebitis (superficial venous thrombosis)

BMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h2039 (Published 22 June 2015) Cite this as: BMJ 2015;350:h2039

Re: Superficial thrombophlebitis (superficial venous thrombosis)

Nasr and Scriven include oestrogen based hormone therapy (HT) as a cause of superficial venous thrombosis.1 Only progestogen dominant HT is used for women with an intact uterus because of the high risk of endometrial cancer with oestrogen dominant HT. All hormonal contraceptives are progestogen dominant to prevent pregnancy and progestogens can cause vasodilation also increase the risk superficial or deep venous thrombosis. 1,2

In 1969, progestogens with inherent estrogenic activity, norethisterone acetate and ethynodiol diacetate, cause most veins complaints, especially when combined with higher doses of oestrogens. Vein complaints, including painful distended veins, varicose veins, leg cramps, superficial thrombophlebitis and thromboembolism, related to dilated endometrial sinusoids with or without stromal condensation.3

In 2011, Thomson et al discovered that desogestrel 150ug and drospirenone 3 mg increased endothelium-dependent vasodilation in large and small peripheral microvasculature further confirming the importance of vasodilation in the aetiology of progestogen/oestrogen induced thrombosis. Acne-treating oestrogenic drospirenone and desogestrel cause more thrombosis than acne-causing androgenic levonorgestrel.

In 2015, Vinogradova et al found that any current exposure to combined oral contraceptives gave a 3-fold increased risk of idiopathic venous thromboembolism compared with no use in the past year. Newer third generation progestins doubled the risk compared with older progestins. Risks were for desogestrel (x4.28), gestodene (x4.27), drospireone (4.12) and cyproterone (4.27) compared with levonorgestrel (2.38), norethisterone (2.56) and norgestimate (2.53).

It is important to that hormone use should be discontinued, along with symptomatic control or anticoagulants, to prevent continuing venous vasodilation leading to venous pulmonary thromboembolism.

1 Nasr H, Scriven JM. Superficial thrombophlebitis (superficial venous thrombosis). BMJ2015;350:h2039.
2 Grant ECG. Hormone balance of oral contraceptives. BJOG 1967;74:908-18.
3 Grant ECG. Venous effects of oral contraceptives. BMJ 1969;2:73-7.
4 Thompson AK, Przemska A, Vasiloupou D, Newens KJ, Williams CM.
Combined oral contraceptive pills containing desogestrel or drospirenone
enhance large vessel and microvasculature vasodilation in healthy
premenopausal women. Microcirculation 2011 Mar 7. doi: 10.1111/j.1549-
8719.2011.00094.x.
5 Vinogradova Y, Coupland C, Hippisley-Cox J. Use of combined oral contraceptives and risk of venous thromboembolism: nested case-control studies using the QResearch and CPRD databases.BMJ 2015;350:h2135

Competing interests: No competing interests

24 June 2015
Ellen Grant
Physician and medical gynaecologist
Retired
Kingston-upon-Thames, KT2 7JU, UK