Assessing the risk of venous thromboembolic events in women taking progestin-only contraception: a meta-analysis
Open accessAbstract
OBJECTIVES: To evaluate the risk of venous thromboembolic events associated with the use of progestin-only contraception and whether that risk differs with the mode of drug delivery (oral, intrauterine, or depot injection). DESIGN: Systematic review and meta-analysis of randomised controlled trials and observational studies. DATA SOURCES: Pubmed, Embase, Cochrane Library, and reference lists of relevant reviews. STUDY SELECTION: Randomised controlled trials and case-control, cohort, and cross sectional studies with venous thromboembolic outcome for progestin-only contraception reported relative to a non-hormone comparator group. DATA EXTRACTION: Data were extracted by two independent investigators, and consensus for inclusion was reached after assessment by additional investigators. RESULTS: Among the 2022 unique references identified by all searches, eight observational studies fulfilled inclusion criteria. A total of 147 women across all studies were diagnosed with a venous thromboembolic event while taking progestin-only contraception, and the summary measure for the adjusted relative risk of a venous thromboembolic episode for users versus non-users of a progestin-only contraceptive was, based on the random effects model, 1.03 (95% CI 0.76 to 1.39). Subgroup analysis confirmed there was no association between venous thromboembolic risk and progestin-only pills (relative risk 0.90 (0.57 to 1.45)) or a progestin intrauterine device (0.61 (0.24 to 1.53)). The relative risk of a venous thromboembolic event for users of an injectable progestin versus non-users was 2.67 (1.29 to 5.53). CONCLUSIONS: Published data assessing the risk of venous thromboembolism in women prescribed progestin-only contraception are limited. In this meta-analysis of eight observational studies, the use of progestin-only contraception was not associated with an increased risk of venous thromboembolism compared with non-users of hormonal contraception. The potential association between injectable progestins and thrombosis requires further study.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
CHC has been shown to increase the risk of thrombosis.
“In patients with high risk of thrombosis who are not fully anticoagulated, CHC and injectable depot medroxyprogesterone acetate (DMPA) should be avoided, and is generally contraindicated, as both have been shown to increase the risk of thrombosis[104, 105].”
From Estrogen and thrombosis: a bench to bedside review (2020) · cites this paper as [105]
Injectable depot medroxyprogesterone acetate (DMPA) has been shown to increase the risk of thrombosis.
“In patients with high risk of thrombosis who are not fully anticoagulated, CHC and injectable depot medroxyprogesterone acetate (DMPA) should be avoided, and is generally contraindicated, as both have been shown to increase the risk of thrombosis[104, 105].”
From Estrogen and thrombosis: a bench to bedside review (2020) · cites this paper as [105]
Injectable progesterone such as DMPA may have a small increase in VTE risk.
“Progestin-only pills are generally considered safe, however, injectable progesterone such as DMPA may have a small increase in VTE risk [104, 105].”
From Estrogen and thrombosis: a bench to bedside review (2020) · cites this paper as [105]
Progestin-only pills are generally considered safe in women with hereditary thrombophilia.
“Progestin-only pills are generally considered safe, however, injectable progesterone such as DMPA may have a small increase in VTE risk [104, 105].”
From Estrogen and thrombosis: a bench to bedside review (2020) · cites this paper as [105]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Cochrane Handbook for Systematic Reviews of Interventions: Cochrane Book Series
(2008) · doi:10.1002/9780470712184 · Cited by 25,048 · see citing works
Dermyshi, E., Wang, Y., Yan, C., Hong, W., Qiu, G., Gong, X., & Zhang, T. (2017) · Neonatology · doi:10.1159/000454668 · Cited by 24,577 · see citing works
Stroup, D. F. (2000) · JAMA · doi:10.1001/jama.283.15.2008 · Cited by 20,623 · see citing works
Sterne, J. A. C., Sutton, A. J., Ioannidis, J. P. A., Terrin, N., Jones, D. R., Lau, J., Carpenter, J., Rucker, G., Harbord, R. M., Schmid, C. H., et al. (2011) · BMJ · doi:10.1136/bmj.d4002 · Cited by 7,709 · see citing works
Self-citationCochrane Handbook for Systematic Reviews of Interventions
Higgins, J. P. T., Green, S., & Ben Van Den, A. (2020) · International Coaching Psychology Review · doi:10.53841/bpsicpr.2020.15.2.123 · Cited by 5,670 · see citing works
U.S. Medical Eligibility Criteria for Contraceptive Use, 2016
Curtis, K. M., Tepper, N. K., Jatlaoui, T. C., Berry-Bibee, E., Horton, L. G., Zapata, L. B., Simmons, K. B., Pagano, H. P., Jamieson, D. J., & Whiteman, M. K. (2016) · MMWR. Recommendations and Reports · doi:10.15585/mmwr.rr6503a1 · Cited by 1,456 · see citing works
Medical-eligibility criteria for contraceptive use
Guillebaud, J. (2001) · The Lancet · doi:10.1016/s0140-6736(00)04615-8 · Cited by 1,095 · see citing works
Pagano, M., Gauvreau, K., & Mattie, H. (2022) · Chapman & Hall/CRC eBooks · doi:10.1201/9780429340512 · Cited by 928 · see citing works
Jick, H., Jick, S. S., Myers, M. W., Vasilakis‐Scaramozza, C., & Gurewich, V. (1995) · The Lancet · doi:10.1016/s0140-6736(95)91928-7 · Cited by 721 · see citing works
Hormonal contraception and risk of venous thromboembolism: national follow-up study
Lidegaard, O., Lokkegaard, E., Svendsen, A. L., & Agger, C. (2009) · BMJ · doi:10.1136/bmj.b2890 · Cited by 709 · see citing works
Vlieg, A. V. H., Helmerhorst, F. M., Vandenbroucke, J. P., Doggen, C. J. M., & Rosendaal, F. R. (2009) · BMJ · doi:10.1136/bmj.b2921 · Cited by 661 · see citing works
Lidegaard, O., Nielsen, L. H., Skovlund, C. W., Skjeldestad, F. E., & Lokkegaard, E. (2011) · BMJ · doi:10.1136/bmj.d6423 · Cited by 608 · see citing works
Medical eligibility criteria for contraceptive use
Trussell, J. (2011) · Human Fertility · doi:10.3109/14647273.2011.602520 · Cited by 485 · see citing works
Alternatively spliced human tissue factor: a circulating, soluble, thrombogenic protein
Bogdanov, V. Y., Balasubramanian, V., Hathcock, J. J., Vele, O. E., Lieb, M., & Nemerson, Y. (2003) · Nature Medicine · doi:10.1038/nm841 · Cited by 467 · see citing works
Third generation oral contraceptives and risk of venous thrombosis: meta-analysis
Kemmeren, J. M., Algra, A., & Grobbee, D. E. (2001) · BMJ · doi:10.1136/bmj.323.7305.131 · Cited by 454 · see citing works
Poulter, N. R., Cl, C., Farley, T., Meirik, O., & Marmot, M. G. (1995) · PubMed · Cited by 404 · see citing works
Ziegel, E. R., Pagano, M. F., & Gauvreau, K. (1994) · Technometrics · doi:10.2307/1269984 · Cited by 359 · see citing works
Oral Contraceptive Estrogen Dose and the Risk of Deep Venous Thromboembolic Disease
Gerstman, B. B., Piper, J. M., Tomita, D. K., Ferguson, W., Stadel, B. V., & Lundin, F. E. (1991) · American Journal of Epidemiology · doi:10.1093/oxfordjournals.aje.a115799 · Cited by 349 · see citing works
U.S. Medical Eligibility Criteria for Contraceptive Use, 2010
Curtis, K. M., Tepper, N. K., & Marchbanks, P. A. (2011) · Journal of Women s Health · doi:10.1089/jwh.2011.2851 · Cited by 262 · see citing works
(1996) · International Journal of Gynecology & Obstetrics · doi:10.1016/0020-7292(96)89711-6 · Cited by 259 · see citing works
Oral contraceptives and venous thromboembolism: findings in a large prospective study.
Vessey, M. P., Mant, D., Smith, A., & Yeates, D. (1986) · BMJ · doi:10.1136/bmj.292.6519.526 · Cited by 257 · see citing works
Rosing, J., Middeldorp, S., Curvers, J., Thomassen, S., Nicolaes, G. A. F., Meijers, J. C. M., Bouma, B. N., Buller, H. R., Prins, M. H., & Tans, G. (1999) · The Lancet · doi:10.1016/s0140-6736(99)06092-4 · Cited by 257 · see citing works
Risk of idiopathic venous thromboembolism in users of progestagens alone
Vasilakis, C., Jick, H., & Melero-Montes, M. D. M. (1999) · The Lancet · doi:10.1016/s0140-6736(99)04394-9 · Cited by 194 · see citing works
Vlieg, A. V. H., Helmerhorst, F. M., & Rosendaal, F. R. (2010) · Arteriosclerosis Thrombosis and Vascular Biology · doi:10.1161/atvbaha.110.211482 · Cited by 175 · see citing works
Kemmeren, J. M., Algra, A., Meijers, J. C. M., Tans, G., Bouma, B. N., Curvers, J., Rosing, J., & Grobbee, D. E. (2004) · Blood · doi:10.1182/blood-2003-04-1285 · Cited by 157 · see citing works
Mead, N., & Roland, M. O. (2009) · BMJ · doi:10.1136/bmj.b3450 · Cited by 152 · see citing works
Poulter, N. R., Cl, C., Farley, T., Marmot, M. G., & Meirik, O. (1998) · PubMed · Cited by 140 · see citing works
Progestogen-only contraception in women at high risk of venous thromboembolism
Conard, J., Plu‐Bureau, G., Bahi, N., Horellou, M., Pelissier, C., & Thalabard, J. (2004) · Contraception · doi:10.1016/j.contraception.2004.07.009 · Cited by 137 · see citing works
Heinemann, L. A. J., Assmann, A., DoMinh, T., & Garbe, E. (1999) · The European Journal of Contraception & Reproductive Health Care · doi:10.3109/13625189909064007 · Cited by 126 · see citing works
Barsoum, M. K., Heit, J. A., Ashrani, A. A., Leibson, C. L., Petterson, T. M., & Bailey, K. R. (2010) · Thrombosis Research · doi:10.1016/j.thromres.2010.08.010 · Cited by 98 · see citing works
Effect of oral contraceptives on thrombin generation measured via calibrated automated thrombography
Tchaikovski, S. N., van Vliet, H. A. A. M., Thomassen, S., Bertina, R. M., Rosendaal, F. R., Sandset, P.-M., Helmerhorst, F. M., Tans, G., & Rosing, J. (2007) · Thrombosis and Haemostasis · doi:10.1160/th07-07-0439 · Cited by 93 · see citing works
Poulter, N. R., Chang, C., Farley, T., & Meirik, O. (1999) · The Lancet · doi:10.1016/s0140-6736(99)03132-3 · Cited by 87 · see citing works
Oral Contraceptives and Thrombotic Disease: Risk of Venous Thromboembolism
Helmerhorst, F. M., Bloemenkamp, K. W. M., Rosendaal, F. R., & Vandenbroucke, J. P. (1997) · Thrombosis and Haemostasis · doi:10.1055/s-0038-1657547 · Cited by 84 · see citing works
van Vliet, H. A. A. M., Bertina, R. M., Dahm, A. E. A., Rosendaal, F. R., Rosing, J., Sandset, P. M., & Helmerhorst, F. M. (2008) · Journal of Thrombosis and Haemostasis · doi:10.1111/j.1538-7836.2007.02863.x · Cited by 82 · see citing works
Sustained intrauterine release of levonorgestrel over five years
Nilsson, C. G., Lähteenmäki, P. L. A., Luukkainen, T., & Robertson, D. N. (1986) · Fertility and Sterility · doi:10.1016/s0015-0282(16)49397-0 · Cited by 78 · see citing works
Nanda, K., Amaral, E. M., Hays, M. A., Viscola, M., Mehta, N., & Bahamondes, L. G. (2007) · Fertility and Sterility · doi:10.1016/j.fertnstert.2007.07.1348 · Cited by 67 · see citing works
Safety and efficacy of levonorgestrel implant, intrauterine device, and sterilization
Meirik, O. (2001) · Obstetrics and Gynecology · doi:10.1016/s0029-7844(00)01220-5 · Cited by 60 · see citing works
Progestin and Thrombin Regulate Tissue Factor Expression in Human Term Decidual Cells
Lockwood, C. J., Murk, W. K., Kayisli, U. A., Buchwalder, L. F., Huang, S.-T. J., Funai, E. F., Krikun, G., & Schatz, F. (2009) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2009-0065 · Cited by 55 · see citing works
Kato, S., Pinto, M. P., Carvajal, A., Espinoza, N., Monso, C., Sadarangani, A., Villalón, M., Brosens, J. J., WHITE, J. O., Richer, J. K., et al. (2005) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2004-0857 · Cited by 55 · see citing works
(1996) · International Journal of Gynecology & Obstetrics · doi:10.1016/0020-7292(96)89714-1 · Cited by 50 · see citing works
Limited knowledge on progestogen‐only contraception and risk of venous thromboembolism
Bergendal, A., Odlind, V., Persson, I. R., & Kieler, H. (2009) · Acta Obstetricia Et Gynecologica Scandinavica · doi:10.1080/00016340902730375 · Cited by 48 · see citing works
Risk factors for recurrence of venous thromboembolism associated with the use of oral contraceptives
Vaillant-Roussel, H., Ouchchane, L., Dauphin, C., Philippe, P., & Ruivard, M. (2011) · Contraception · doi:10.1016/j.contraception.2011.06.008 · Cited by 43 · see citing works
Stanczyk, F. Z., Mroszczak, E. J., Ling, T. L., Runkel, R., Henzl, M. R., Miyakawa, I., & Goebelsmann, U. (1983) · Contraception · doi:10.1016/0010-7824(83)90065-3 · Cited by 24 · see citing works
Shirk, R. A., Zhang, Z., & Winneker, R. C. (2005) · The Journal of Steroid Biochemistry and Molecular Biology · doi:10.1016/j.jsbmb.2004.12.026 · Cited by 12 · see citing works
Differential effects of medroxyprogesterone acetate on thrombosis and atherosclerosis in mice
Freudenberger, T., Oppermann, M., Marzoll, A., Heim, H., Mayer, P. E., Kojda, G., Weber, A. A., Schrör, K., & Fischer, J. W. (2009) · British Journal of Pharmacology · doi:10.1111/j.1476-5381.2009.00470.x · Cited by 11 · see citing works
Hormonal contraception in thrombophilic adolescents
Rott, H. (2011) · Hämostaseologie · doi:10.5482/ha-1177 · Cited by 10 · see citing works
Safety and Efficacy of Levonorgestrel Implant, Intrauterine Device, and Sterilization
Meirik, O., Farley, T. M. M., & Sivin, I. (2001) · Obstetrics and Gynecology · doi:10.1097/00006250-200104000-00012 · Cited by 10 · see citing works
Flagged first, then by citations
1 of the 48 references couldn’t be matched to a known paper.
Research works printed but not linked: 2
- Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, et al for the Meta-analysis Of Observational Studies in Epidemiology (MOOSE) Group. Meta-analysis of observational studies in epidemiology: a proposal for reporting. JAMA 2000;283:2008-12.
- No commercial reuse: See rights and reprints http://www.bmj.com/permissions Subscribe: http://www.bmj.com/subscribe
Cited by
Sorted by citations
Mancia, G., Kreutz, R., Brunström, M., Burnier, M., Grassi, G., Januszewicz, A., Muiesan, M. L., Tsioufis, K., Agabiti-Rosei, E., Algharably, E. A. E., et al. (2023) · Journal of Hypertension · doi:10.1097/hjh.0000000000003480 · Cited by 3,473 · see citing works
Virani, S. S., Newby, L. K., Arnold, S. V., Bittner, V., Brewer, L. C., Demeter, S. H., Dixon, D. L., Fearon, W. F., Hess, B., Johnson, H. M., et al. (2023) · Circulation · doi:10.1161/cir.0000000000001168 · Cited by 1,598 · see citing works
Anders, H., Saxena, R., Zhao, M., Parodis, I., Salmon, J. E., & Mohan, C. (2020) · Nature Reviews Disease Primers · doi:10.1038/s41572-019-0141-9 · Cited by 998 · see citing works
Sammaritano, L. R., Bermas, B. L., Chakravarty, E. F., Chambers, C., Clowse, M. E. B., Lockshin, M. D., Marder, W., Guyatt, G. H., Branch, D. W., Buyon, J. P., et al. (2020) · Arthritis & Rheumatology · doi:10.1002/art.41191 · Cited by 823 · see citing works
Virani, S. S., Newby, L. K., Arnold, S. V., Bittner, V., Brewer, L. C., Demeter, S. H., Dixon, D. L., Fearon, W. F., Hess, B., Johnson, H. M., et al. (2023) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2023.04.003 · Cited by 596 · see citing works
Contraception Selection, Effectiveness, and Adverse Effects
Teal, S. B., & Edelman, A. B. (2021) · JAMA · doi:10.1001/jama.2021.21392 · Cited by 371 · see citing works
2025 ESC Guidelines for the management of cardiovascular disease and pregnancy
Backer, J. F. A. D., Haugaa, K. H., Hasselberg, N. E., de Hosson, M., Brida, M., Castelletti, S., Cauldwell, M., Cerbai, E., Crotti, L., de Groot, N. M. S., et al. (2025) · European Heart Journal · doi:10.1093/eurheartj/ehaf193 · Cited by 365 · see citing works
Statement on Pregnancy in Pulmonary Hypertension from the Pulmonary Vascular Research Institute
Hemnes, A. R., Kiely, D. G., Cockrill, B. A., Safdar, Z., Wilson, V. J., Hazmi, M. A., Preston, I. R., MacLean, M. R., & Lahm, T. (2015) · Pulmonary Circulation · doi:10.1086/682230 · Cited by 338 · see citing works
Sammaritano, L. R., Bermas, B. L., Chakravarty, E. F., Chambers, C., Clowse, M. E. B., Lockshin, M. D., Marder, W., Guyatt, G. H., Branch, D. W., Buyon, J. P., et al. (2020) · Arthritis Care & Research · doi:10.1002/acr.24130 · Cited by 333 · see citing works
Progestin-only contraception and thromboembolism: A systematic review
Tepper, N. K., Whiteman, M. K., Marchbanks, P. A., James, A., & Curtis, K. M. (2016) · Contraception · doi:10.1016/j.contraception.2016.04.014 · Cited by 273 · see citing works
Estrogen and thrombosis: a bench to bedside review
Abou-Ismail, M. Y., Citla Sridhar, D., & Nayak, L. (2020) · Thrombosis Research · doi:10.1016/j.thromres.2020.05.008 · Cited by 261 · see citing works
Martinelli, I., Lensing, A. W. A., Middeldorp, S., Levi, M., Beyer-Westendorf, J., van Bellen, B., Bounameaux, H., Brighton, T. A., Cohen, A. T., Trajanovic, M., et al. (2016) · Blood · doi:10.1182/blood-2015-08-665927 · Cited by 219 · see citing works
Sex Differences in Systemic Lupus Erythematosus
Nusbaum, J., Mirza, I., Shum, J., Freilich, R. W., Cohen, R. E., Pillinger, M. H., Izmirly, P., & Buyon, J. P. (2020) · Mayo Clinic Proceedings · doi:10.1016/j.mayocp.2019.09.012 · Cited by 169 · see citing works
(2019) · Obstetrics & Gynecology · doi:10.1097/aog.0000000000003072 · Cited by 147 · see citing works
Pregnancy in pulmonary arterial hypertension
Olsson, K. M., & Channick, R. N. (2016) · European Respiratory Review · doi:10.1183/16000617.0079-2016 · Cited by 147 · see citing works
Glisic, M., Shahzad, S., Tsoli, S., Chadni, M., Asllanaj, E., Rojas, L. Z., Brown, E., Chowdhury, R., Muka, T., & Franco, O. H. (2018) · European Journal of Preventive Cardiology · doi:10.1177/2047487318774847 · Cited by 124 · see citing works
Hormonal therapies and venous thrombosis: Considerations for prevention and management
Lavasseur, C. M., Neukam, S., Kartika, T., Bannow, B. S., Shatzel, J. J., & DeLoughery, T. G. (2022) · Research and Practice in Thrombosis and Haemostasis · doi:10.1002/rth2.12763 · Cited by 103 · see citing works
Contraception and cardiovascular disease
Roos‐Hesselink, J. W., Cornette, J. M. J., Sliwa, K. S., Pieper, P. G., VELDTMAN, G. R., & Johnson, M. R. (2015) · European Heart Journal · doi:10.1093/eurheartj/ehv141 · Cited by 98 · see citing works
Venous thromboembolism in women: a specific reproductive health risk
ESHRE Capri Workshop Group, Eichinger, S., Evers, J. L. H., Glasier, A., Vecchia, C. L., Martinelli, I., Skouby, S. O., Somigliana, E., Baird, D., Benagiano, G., et al. (2013) · Human Reproduction Update · doi:10.1093/humupd/dmt028 · Cited by 97 · see citing works
Association of venous thromboembolism with hormonal contraception and thrombophilic genotypes
Bergendal, A., Persson, I., Odeberg, J., Sundström, A., Holmström, M., Schulman, S., Björgell, O., & Kieler, H. (2014) · Obstetrics & Gynecology · doi:10.1097/aog.0000000000000411 · Cited by 93 · see citing works
Gérard, C., Arnal, J., Jost, M., Douxfils, J., Lenfant, F., Fontaine, C., Houtman, R., Archer, D. F., Reid, R. L., Løbo, R. A., et al. (2022) · Expert Review of Clinical Pharmacology · doi:10.1080/17512433.2022.2054413 · Cited by 90 · see citing works
Gemzell‐Danielsson, K., Apter, D. L., Zatik, J., Weyers, S., Piltonen, T., Сутурина, Л. В., Анатольевна, А. И., Jost, M., Creinin, M. D., & Foidart, J. (2021) · BJOG An International Journal of Obstetrics & Gynaecology · doi:10.1111/1471-0528.16840 · Cited by 83 · see citing works
Progestin and breast cancer risk: a systematic review
Samson, M. E., Porter, N. R., Orekoya, O., Hébert, J. R., Adams, S. A., Bennett, C. L., & Steck, S. E. (2015) · Breast Cancer Research and Treatment · doi:10.1007/s10549-015-3663-1 · Cited by 83 · see citing works
Association of Hormonal Contraceptive Use With Adverse Health Outcomes
Brabaharan, S., Veettil, S. K., Kaiser, J. E., Rao, V. R. R., Wattanayingcharoenchai, R., Maharajan, M. K., Insin, P., Talungchit, P., Anothaisintawee, T., Thakkinstian, A., et al. (2022) · JAMA Network Open · doi:10.1001/jamanetworkopen.2021.43730 · Cited by 77 · see citing works
Bellizzi, S., Sobel, H. L., Obara, H., & Temmerman, M. (2015) · Human Reproduction · doi:10.1093/humrep/deu348 · Cited by 73 · see citing works
Levonorgestrel-releasing intra-uterine systems as female contraceptives
Grandi, G., Farulla, A., Sileo, F. G., & Facchinetti, F. (2018) · Expert Opinion on Pharmacotherapy · doi:10.1080/14656566.2018.1462337 · Cited by 64 · see citing works
de Melo, A. S., dos Reis, R. M., Ferriani, R. A., & Vieira, C. (2017) · Open Access Journal of Contraception · doi:10.2147/oajc.s85543 · Cited by 61 · see citing works
Association of Progestogens and Venous Thromboembolism Among Women of Reproductive Age
Cockrum, R. H., Soo, J., Ham, S. A., Cohen, K. S., & Snow, S. G. (2022) · Obstetrics and Gynecology · doi:10.1097/aog.0000000000004896 · Cited by 60 · see citing works
Mijatovic, V., & Vercellini, P. (2024) · Human Reproduction · doi:10.1093/humrep/dead262 · Cited by 60 · see citing works
Hormonal contraception in women with migraine: is progestogen-only contraception a better choice?
Nappi, R. E., Merki‐Feld, G. S., Terreno, E., Pellegrinelli, A., & Viana, M. (2013) · The Journal of Headache and Pain · doi:10.1186/1129-2377-14-66 · Cited by 59 · see citing works
Avdeev, S. N., Барбараш, О. Л., Баутин, А. Е., Volkov, A. V., Veselova, T. N., Galyavich, A. S., Goncharova, N. S., Gorbachevsky, S. V., Danilov, N. M., Еременко, А. А., et al. (2021) · Russian Journal of Cardiology · doi:10.15829/1560-4071-2021-4683 · Cited by 57 · see citing works
Warhurst, S., Rofe, C., Brew, B. J., Bateson, D. J., McGeechan, K., Merki‐Feld, G. S., Garrick, R., & Tomlinson, S. E. (2017) · Cephalalgia · doi:10.1177/0333102417710636 · Cited by 57 · see citing works
How I treat heavy menstrual bleeding associated with anticoagulants
Boonyawat, K., O’Brien, S. H., & Bates, S. M. (2017) · Blood · doi:10.1182/blood-2017-07-797423 · Cited by 55 · see citing works
Ramírez, I. C., de la Viuda, E., Baquedano, L., Coronado, P., Llaneza, P., Mendoza, N., Otero, B., Sánchez, S., Hidalgo, M. J. C., Páramo, J. A., et al. (2020) · Maturitas · doi:10.1016/j.maturitas.2020.04.019 · Cited by 51 · see citing works
Long‐term use of dienogest for the treatment of primary and secondary dysmenorrhea
Osuga, Y., Hayashi, K., & Kanda, S. (2020) · Journal of obstetrics and gynaecology research · doi:10.1111/jog.14209 · Cited by 51 · see citing works
Lete, I., Chabbert‐Buffet, N., Jamin, C., Lello, S., Lobo, P., Nappi, R. E., & Pintiaux, A. (2015) · The European Journal of Contraception & Reproductive Health Care · doi:10.3109/13625187.2015.1050091 · Cited by 47 · see citing works
Membranous Lupus Nephritis: A Clinical Review
Almaani, S. J., & Parikh, S. V. (2019) · Advances in Chronic Kidney Disease · doi:10.1053/j.ackd.2019.08.009 · Cited by 47 · see citing works
How I diagnose and treat venous thromboembolism in sickle cell disease
Shet, A. S., & Wun, T. (2018) · Blood · doi:10.1182/blood-2018-03-822593 · Cited by 45 · see citing works
Sex matters: Practice 5P's when treating young women with venous thromboembolism
Bistervels, I. M., Scheres, L. J. J., Hamulyák, E. N., & Middeldorp, S. (2019) · Journal of Thrombosis and Haemostasis · doi:10.1111/jth.14549 · Cited by 44 · see citing works
Estrogen, progestin, and beyond: thrombotic risk and contraceptive choices
Skeith, L., & Bates, S. M. (2024) · Hematology · doi:10.1182/hematology.2024000591 · Cited by 41 · see citing works
Risk of recurrent venous thromboembolism on progestin-only contraception: a cohort study
Moigne, E. L., Tromeur, C., Delluc, A., Gouillou, M., Alavi, Z., Lacut, K., Mottier, D., & Gal, G. L. (2015) · Haematologica · doi:10.3324/haematol.2015.134882 · Cited by 41 · see citing works
Attini, R., Cabiddu, G., Montersino, B., Gammaro, L., Gernone, G., Moroni, G. L., Santoro, D., Spotti, D., Masturzo, B., Gazzani, I. B., et al. (2020) · Journal of Nephrology · doi:10.1007/s40620-020-00717-0 · Cited by 39 · see citing works
Systemic lupus erythematosus: strategies to improve pregnancy outcomes
Aoki, S., & Yamamoto, Y. (2016) · International Journal of Women s Health · doi:10.2147/ijwh.s90157 · Cited by 38 · see citing works
Risk of venous thromboembolism in immune-mediated inflammatory diseases: a UK matched cohort study
Galloway, J. B., Barrett, K. J., Irving, P. M., Khavandi, K., Nijher, M., Nicholson, R., de Lusignan, S., & Buch, M. H. (2020) · RMD Open · doi:10.1136/rmdopen-2020-001392 · Cited by 38 · see citing works
Skeith, L., Gal, G. L., & Rodger, M. A. (2021) · Thrombosis Research · doi:10.1016/j.thromres.2021.03.012 · Cited by 38 · see citing works
Obesity and hormonal contraception: an overview and a clinician’s practical guide
Cipriani, S., Todisco, T., Scavello, I., Stasi, V. D., Maseroli, E., & Vignozzi, L. (2019) · Eating and Weight Disorders - Studies on Anorexia Bulimia and Obesity · doi:10.1007/s40519-019-00774-w · Cited by 37 · see citing works
Venous thromboembolism and women's health
Speed, V., Roberts, L. N., Patel, J. P., & Arya, R. (2018) · British Journal of Haematology · doi:10.1111/bjh.15608 · Cited by 36 · see citing works
Management of Systemic Lupus Erythematosus During Pregnancy
Sammaritano, L. R. (2016) · Annual Review of Medicine · doi:10.1146/annurev-med-042915-102658 · Cited by 35 · see citing works
Eissa, A. A., Tuck, S. M., Rantell, K. R., & Stott, D. (2014) · Journal of Family Planning and Reproductive Health Care · doi:10.1136/jfprhc-2013-100763 · Cited by 35 · see citing works
Prada-Ramallal, G., Roque, F., Herdeiro, M. T., Takkouche, B., & Figueiras, A. (2018) · BMC Medical Research Methodology · doi:10.1186/s12874-018-0561-3 · Cited by 33 · see citing works
Pyra, M. N., Casimiro, I., Rusie, L. K., Ross, N., Blum, C., Baker, K. K., Baker, A., & Schneider, J. A. (2020) · Transgender Health · doi:10.1089/trgh.2019.0061 · Cited by 33 · see citing works
Sugiura, K., Kobayashi, T., & Ojima, T. (2015) · Thrombosis Research · doi:10.1016/j.thromres.2015.11.038 · Cited by 33 · see citing works
Ge, S., Tao, X., Cai, L.-S., Deng, X., Hwang, M.-F., & Wang, C.-L. (2018) · Journal of Investigative Medicine · doi:10.1136/jim-2018-000750 · Cited by 32 · see citing works
Canadian Contraception Consensus (Part 3 of 4): Chapter 8 – Progestin-Only Contraception
Black, A., Guilbert, É., Costescu, D., Dunn, S., Fisher, W. A., Kives, S. L., Mirosh, M., Norman, W. V., Pymar, H. C., Reid, R. L., et al. (2016) · Journal of Obstetrics and Gynaecology Canada · doi:10.1016/j.jogc.2015.12.003 · Cited by 32 · see citing works
Faro, V. L., Johansson, T., & Johansson, Å. (2023) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2023.09.012 · Cited by 31 · see citing works
Development of controlled release systems over the past 50 years in the area of contraception
Friend, D. R. (2015) · Journal of Controlled Release · doi:10.1016/j.jconrel.2015.12.043 · Cited by 29 · see citing works
Limdi, J. K., Farraye, J., Cannon, R., Woodhams, E. J., & Farraye, F. A. (2019) · Inflammatory Bowel Diseases · doi:10.1093/ibd/izz025 · Cited by 29 · see citing works
Foidart, J., Gaspard, U., Péqueux, C., Jost, M., Gordenne, V., Tskitishvili, E., Gallez, A., Valera, M., Gourdy, P., Fontaine, C., et al. (2019) · ISGE series · doi:10.1007/978-3-030-11355-1_12 · Cited by 28 · see citing works
Contraception and preconception counseling in women with autoimmune disease
Sammaritano, L. R. (2019) · Best Practice & Research Clinical Obstetrics & Gynaecology · doi:10.1016/j.bpobgyn.2019.09.003 · Cited by 28 · see citing works
Does the Progestogen Used in Combined Hormonal Contraception Affect Venous Thrombosis Risk?
Han, L. L., & Jensen, J. T. (2015) · Obstetrics and Gynecology Clinics of North America · doi:10.1016/j.ogc.2015.07.007 · Cited by 27 · see citing works
The contraception needs of the perimenopausal woman
Hardman, S. M., & Gebbie, A. E. (2014) · Best Practice & Research Clinical Obstetrics & Gynaecology · doi:10.1016/j.bpobgyn.2014.05.006 · Cited by 26 · see citing works
Contraceptive and hormonal treatment options for women with history of venous thromboembolism
Stam‐Slob, M. C., Lambalk, C. B., & van de Ree, M. A. (2015) · BMJ · doi:10.1136/bmj.h4847 · Cited by 26 · see citing works
Sech, L. A., & Mishell, D. R. (2015) · Women s Health · doi:10.2217/whe.15.82 · Cited by 26 · see citing works
Pulmonary Arterial Hypertension in Women
Memon, H. A., & Park, M. (2017) · Methodist DeBakey Cardiovascular Journal · doi:10.14797/mdcj-13-4-224 · Cited by 26 · see citing works
Grossesse et hypertension artérielle pulmonaire
Ladouceur, M. (2019) · La Presse Médicale · doi:10.1016/j.lpm.2019.08.007 · Cited by 25 · see citing works
Reproductive health care after transplantation
Krajewski, C. M., & Sucato, G. S. (2014) · Best Practice & Research Clinical Obstetrics & Gynaecology · doi:10.1016/j.bpobgyn.2014.09.002 · Cited by 25 · see citing works
Progestin-only contraception and thrombosis: An updated systematic review
Tepper, N. K., Nguyen, A. T., Whiteman, M. K., & Curtis, K. M. (2025) · Contraception · doi:10.1016/j.contraception.2025.110978 · Cited by 23 · see citing works
Chabbert‐Buffet, N., Marret, H., Agostini, A., Cardinale, C., Hamdaoui, N., Hassoun, D., Jonville‐Béra, A. ‐., Lambert, M., Linet, T., Pienkowski, C., et al. (2019) · Journal of Gynecology Obstetrics and Human Reproduction · doi:10.1016/j.jogoh.2019.04.009 · Cited by 23 · see citing works
Oral contraception for women of middle age
Ruan, X., & Mueck, A. O. (2015) · Maturitas · doi:10.1016/j.maturitas.2015.06.030 · Cited by 23 · see citing works
FSRH Guideline (April 2019) Overweight, Obesity and Contraception
(2019) · BMJ Sexual & Reproductive Health · doi:10.1136/bmjsrh-2019-ooc · Cited by 21 · see citing works
Sex Hormone Influences on Venous Thrombotic and Cardiovascular Risk
Skeith, L., & Bates, S. M. (2026) · New England Journal of Medicine · doi:10.1056/nejmra2202438 · Cited by 20 · see citing works
Sanctis, V. D. (2020) · Mediterranean Journal of Hematology and Infectious Diseases · doi:10.4084/mjhid.2020.032 · Cited by 20 · see citing works
Contraception hormonale et risque vasculaire. RPC Contraception CNGOF
Plu‐Bureau, G., Sabbagh, E., & Hugon‐Rodin, J. (2018) · Gynécologie Obstétrique Fertilité & Sénologie · doi:10.1016/j.gofs.2018.10.007 · Cited by 19 · see citing works
Contraceptive use and counseling in patients with systemic lupus erythematosus
Silverstein, R. G., Fitz, V. W., Thornton, M., Carter, A., & Morse, J. E. (2021) · Contraception · doi:10.1016/j.contraception.2021.08.017 · Cited by 18 · see citing works
Thromboembolism as the adverse event of combined oral contraceptives in Japan
Sugiura, K., Kobayashi, T., & Ojima, T. (2015) · Thrombosis Research · doi:10.1016/j.thromres.2015.09.011 · Cited by 18 · see citing works
Horton, L. G., Folger, S. G., Berry‐Bibee, E., Jatlaoui, T. C., Tepper, N. K., & Curtis, K. M. (2016) · Contraception · doi:10.1016/j.contraception.2016.07.017 · Cited by 18 · see citing works
Sex hormone-binding globulin and thrombin generation in women using hormonal contraception
Hugon‐Rodin, J., Alhenc‐Gelas, M., Hemker, H. C., Brailly‐Tabard, S., Guiochon‐Mantel, A., Plu‐Bureau, G., & Scarabin, P. (2016) · Biomarkers · doi:10.1080/1354750x.2016.1204010 · Cited by 18 · see citing works
Progestins in Combined Contraceptives
Guerra, J. A., Lopez-Munoz, F. J., & Álamo, C. (2013) · Journal of Experimental & Clinical Medicine · doi:10.1016/j.jecm.2013.02.007 · Cited by 17 · see citing works
Safety of hormonal contraception for obese women
Rocha, A. L. L., Campos, R. R., Miranda, M. M. S., Raspante, L. B. D. P., Carneiro, M. M., Vieira, C. S., & dos Reis, F. M. (2017) · Expert Opinion on Drug Safety · doi:10.1080/14740338.2018.1389893 · Cited by 17 · see citing works
Farge, D., Maignan, C. L., Doucet, L. S., & Frère, C. (2019) · Thrombosis Research · doi:10.1016/s0049-3848(19)30367-6 · Cited by 16 · see citing works
Hormones and thrombosis: risk across the reproductive years and beyond
Machin, N., & Ragni, M. V. (2020) · Translational research · doi:10.1016/j.trsl.2020.06.011 · Cited by 16 · see citing works
Which Hormones and Contraception for Women with APS? Exogenous Hormone Use in Women with APS
Sammaritano, L. R. (2021) · Current Rheumatology Reports · doi:10.1007/s11926-021-01006-w · Cited by 16 · see citing works
Sharma, K. J., Afshar, Y., Merz, C. N. B., Tapson, V. F., Zakowski, M. I., & Kilpatrick, S. J. (2016) · Pulmonary Circulation · doi:10.1086/685113 · Cited by 15 · see citing works
Management of anticoagulant-refractory thrombotic antiphospholipid syndrome
Cohen, H., Sayar, Z., Efthymiou, M., Gaspar, P., Richards, T., & Isenberg, D. A. (2020) · The Lancet Haematology · doi:10.1016/s2352-3026(20)30116-2 · Cited by 15 · see citing works
Baldwin, M. K., Bannow, B. S., Rosovsky, R. P. G., Sokkary, N. A., & Srivaths, L. V. (2023) · Research and Practice in Thrombosis and Haemostasis · doi:10.1016/j.rpth.2023.100161 · Cited by 14 · see citing works
Shlyakhto, E. V., Sukhikh, G. T., Serov, V. N., Dedov, I. I., Arutyunov, G. P., Suchkov, I. A., Orlova, Y. A., Andreeva, E. N., Yureneva, S. V., Yavelov, I. S., et al. (2023) · Problems of Endocrinology · doi:10.14341/probl13394 · Cited by 14 · see citing works
Oral hormonal contraceptives and cardiovascular risks in females
Bhullar, S. K., Rabinovich-Nikitin, I., & Kirshenbaum, L. A. (2024) · Canadian Journal of Physiology and Pharmacology · doi:10.1139/cjpp-2024-0041 · Cited by 14 · see citing works
Archer, D. F., Thomas, M. A., Conard, J., Merkatz, R. B., Creasy, G. W., Roberts, K. D., Plagianos, M. G., Blithe, D., & Sitruk-Ware, R. L. (2015) · Contraception · doi:10.1016/j.contraception.2015.09.008 · Cited by 14 · see citing works
Cotton, C. C., Baird, D. D., Sandler, R. S., & Long, M. D. (2016) · Inflammatory Bowel Diseases · doi:10.1097/mib.0000000000000800 · Cited by 14 · see citing works
Pires, A. L. R., Batista, J. G., Aldrighi, J. M., Massaia, I. F. D. S., Delgado, D. M., Filho, E. S. F., & Soares, J. M. (2020) · Revista da Associação Médica Brasileira · doi:10.1590/1806-9282.66.s2.22 · Cited by 13 · see citing works
Contraception for adolescents with chronic rheumatic diseases
Lourenço, B., Kozu, K. T., Leal, G. N., Silva, M. F., Fernandes, E. G. C., França, C. M. P., de Souza, F. H. C., & Silva, C. A. (2016) · Revista Brasileira de Reumatologia (English Edition) · doi:10.1016/j.rbre.2016.07.016 · Cited by 13 · see citing works
Reversible female contraceptives: historical, current, and future perspectives
Barton, B. E., Erickson, J. A., Allred, S., Jeffries, J. M., Stephens, K. K., Hunter, M. I., Woodall, K. A., & Winuthayanon, W. (2023) · Biology of Reproduction · doi:10.1093/biolre/ioad154 · Cited by 12 · see citing works
Ardura, M. I., Coscia, L. A., & Meyers, M. R. (2021) · Pediatric Transplantation · doi:10.1111/petr.13949 · Cited by 12 · see citing works
Braga, G. C., Brito, M. B., Ferriani, R. A., de Oliveira, L. C. O., Garcia, A. A., Pintão, M. C., & Vieira, C. S. (2013) · Contraception · doi:10.1016/j.contraception.2013.06.012 · Cited by 12 · see citing works
Jt, C., & Kotani, K. (2017) · Journal of Clinical Medicine Research · doi:10.14740/jocmr3307w · Cited by 12 · see citing works
Ueda, Y., Kamiya, C., Horiuchi, C., Miyoshi, T., Hazama, R., Tsuritani, M., Iwanaga, N., Neki, R., Ikeda, T., & Yoshimatsu, J. (2018) · Journal of obstetrics and gynaecology research · doi:10.1111/jog.13828 · Cited by 12 · see citing works
Sugiura, K., Kobayashi, T., & Ojima, T. (2020) · Journal of obstetrics and gynaecology research · doi:10.1111/jog.14452 · Cited by 12 · see citing works
Women’s health in The BMJ : a data science history
Hamulyák, E. N., Brockmeier, A. J., Killas, J. D., Ananiadou, S., Middeldorp, S., & Leroi, A. M. (2020) · BMJ Open · doi:10.1136/bmjopen-2020-039759 · Cited by 12 · see citing works
Management considerations for patients with uterine fibroids and concurrent venous thromboembolism
Moulder, J. K., Siedhoff, M. T., Till, S. R., & Moll, S. (2016) · Current Opinion in Obstetrics & Gynecology · doi:10.1097/gco.0000000000000286 · Cited by 11 · see citing works
Kobayashi, T., Sugiura, K., & Ojima, T. (2017) · Journal of obstetrics and gynaecology research · doi:10.1111/jog.13304 · Cited by 11 · see citing works
- Authors
- Mantha, S., Karp, R., Raghavan, V., Terrin, N., Bauer, K. A., & Zwicker, J. I.
- Affiliations
- Lahey Hospital and Medical Center (US)
- Mount Auburn Hospital (US)
- Tufts Medical Center (US)
- Beth Israel Deaconess Medical Center (US)
- Corresponding author
- Zwicker, J. I.
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2012-08-07
- Volume
- 345
- Issue
- aug07 2
- Pages
- e4944-e4944
- ISSN
- 1756-1833 (ISSN-L)
- PMC
- PMC3413580
- OpenAlex
- W2167745220
- Cited by
- 258
- References
- 48
- Citations by year
- 2026: 8 · 2025: 21 · 2024: 17 · 2023: 16 · 2022: 15 · 2021: 14 · 2020: 28 · 2019: 26 · 2018: 18 · 2017: 19 · 2016: 28 · 2015: 18 · 2014: 14 · 2013: 12 · 2012: 4
- FWCI
- 3.07
- 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)
- Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
- HighWire Press Open Archive (submittedVersion)
- Funders
- National Institutes of Health
- National Center for Research Resources (UL1RR025752)
- 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 thromboembolism, progestin-only contraception, hormonal contraception, progestin-only pills, thrombosis risk
- MeSH terms
- Administration, Oral, Contraceptive Agents, Female, Delayed-Action Preparations, Epidemiologic Methods, Female, Humans, Intrauterine Devices, Medicated, Progestins, Venous Thromboembolism
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
