Venous thrombosis in users of non-oral hormonal contraception: follow-up study, Denmark 2001-10
Open accessAbstract
OBJECTIVE: To assess the risk of venous thrombosis in current users of non-oral hormonal contraception. DESIGN: Historical national registry based cohort study. SETTING: Four national registries in Denmark. PARTICIPANTS: All Danish non-pregnant women aged 15-49 (n=1,626,158), free of previous thrombotic disease or cancer, were followed from 2001 to 2010. MAIN OUTCOME MEASURES: Incidence rate of venous thrombosis in users of transdermal, vaginal, intrauterine, or subcutaneous hormonal contraception, relative risk of venous thrombosis compared with non-users, and rate ratios of venous thrombosis in current users of non-oral products compared with the standard reference oral contraceptive with levonorgestrel and 30-40 µg oestrogen. Diagnoses were confirmed by at least four weeks of anticoagulation therapy after the diagnosis. RESULTS: Within 9,429,128 woman years of observation, 5287 first ever venous thrombosis events were recorded, of which 3434 were confirmed. In non-users of hormonal contraception the incidence rate of confirmed events was 2.1 per 10,000 woman years. Compared with non-users of hormonal contraception, and after adjustment for age, calendar year, and education, the relative risk of confirmed venous thrombosis in users of transdermal combined contraceptive patches was 7.9 (95% confidence interval 3.5 to 17.7) and of the vaginal ring was 6.5 (4.7 to 8.9). The corresponding incidences per 10,000 exposure years were 9.7 and 7.8 events. The relative risk was increased in women who used subcutaneous implants (1.4, 0.6 to 3.4) but not in those who used the levonorgestrel intrauterine system (0.6, 0.4 to 0.8). Compared with users of combined oral contraceptives containing levonorgestrel, the adjusted relative risk of venous thrombosis in users of transdermal patches was 2.3 (1.0 to 5.2) and of the vaginal ring was 1.9 (1.3 to 2.7). CONCLUSION: Women who use transdermal patches or vaginal rings for contraception have a 7.9 and 6.5 times increased risk of confirmed venous thrombosis compared with non-users of hormonal contraception of the same age, corresponding to 9.7 and 7.8 events per 10,000 exposure years. The risk was slightly increased in women using subcutaneous implants but not in those using the levonorgestrel intrauterine system.
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There is an increased risk of venous or arterial embolism with estroprogestins and progestin-only drugs.
“There is an increased risk of venous or arterial embolism [65,66,67].”
From Endometriosis and Medical Therapy: From Progestogens to Progesterone Resistance to GnRH Antagonists: A Review (2021) · cites this paper as [66]
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- Authors
- Lidegaard, O., Nielsen, L. H., Skovlund, C. W., & Lokkegaard, E.
- Affiliations
- University of Copenhagen (DK)
- ORCID
- Skovlund, C. W.
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2012-05-10
- Volume
- 344
- Issue
- may10 3
- Pages
- e2990-e2990
- ISSN
- 1756-1833 (ISSN-L)
- PMC
- PMC3349780
- OpenAlex
- W2153677157
- Cited by
- 326
- References
- 19
- Citations by year
- 2026: 16 · 2025: 26 · 2024: 16 · 2023: 20 · 2022: 17 · 2021: 18 · 2020: 12 · 2019: 15 · 2018: 23 · 2017: 19 · 2016: 25 · 2015: 29 · 2014: 36 · 2013: 35 · 2012: 17
- FWCI
- 25.32
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by-nc
- Locations
- BMJ (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (submittedVersion)
- Funders
- Rigshospitalet
- Topics
- Health Sciences › Medicine › Internal Medicine › Venous Thromboembolism Diagnosis and Management
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Health and Contraception
- Health Sciences › Medicine › Hematology › Blood Coagulation and Thrombosis Mechanisms
- Keywords
- venous thrombosis, contraceptive patch, vaginal ring, subdermal contraceptive implant, levonorgestrel-releasing intrauterine system, combined oral contraceptives, thrombosis risk, women of reproductive age, Denmark
- MeSH terms
- Adolescent, Adult, Anticoagulants, Contraceptive Agents, Female, Contraceptive Devices, Female, Contraceptives, Oral, Combined, Contraceptives, Oral, Hormonal, Denmark, Drug Implants, Epidemiologic Methods, Female, Humans, Middle Aged, Norgestrel, Levonorgestrel, Venous Thrombosis, Young Adult, Transdermal Patch
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