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Oral contraceptives and venous thromboembolic disease: the findings from database studies in the United Kingdom and Germany.
Am J Obstet Gynecol. 1998 Sep; 179(3 Pt 2):S78-86.AJ

Abstract

OBJECTIVE

Three research articles published in late 1995 and early 1996 suggested that oral contraceptives containing either of the newer progestogens (gestodene or desogestrel) could be associated with an increased risk of venous thromboembolism. During the months after the initial publications, the results have been scrutinized with great care and further studies have been published. The findings of 2 recent database studies, 1 in the United Kingdom and 1 in Germany, are presented in this article.

PATTERNS OF USE

The average age of users of combined oral contraceptives in Germany was 27 years, compared with 26 years in the United Kingdom. In Germany the use of gestodene-based products was lower than that in the United Kingdom. In the United Kingdom the users of desogestrel with 20 microg ethinyl estradiol (Mercilon) were older than the users of desogestrel with 30 microg ethinyl estradiol (Marvelon).

CRUDE INCIDENCE

The crude incidence of venous thromboembolism in the UK study was 4.1 cases/10,000 woman-y exposure to combined oral contraceptives. In Germany it was 4.2 cases/10,000 woman-y. In Germany the rates among users of second-generation combined oral contraceptives were higher than those among users of third-generation products. The reverse was the case in the United Kingdom. In the United Kingdom the crude incidence rates were higher for the 20 microg estrogen desogestrel product than for the 30 microg product. CASE-CONTROL ANALYSIS: The adjusted odds ratios in the UK study did not show significant increases for desogestrel or gestodene compared with levonorgestrel products. There were inconsistencies in the results among centers in the 2 international studies (the World Health Organization and Transnational studies). In both there was a consistent inverse dose-response relationship with estrogen in all centers.

CONCLUSION

The limitations of the observational studies are such that the hypothesis that the newer progestogens are more likely to cause venous thromboembolism cannot be proved.

Authors+Show Affiliations

Department of Public Health and Epidemiology, Imperial College of Science, Technology, and Medicine, University of London, Guilford, England.No affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

9753314

Citation

Farmer, R D., and R A. Lawrenson. "Oral Contraceptives and Venous Thromboembolic Disease: the Findings From Database Studies in the United Kingdom and Germany." American Journal of Obstetrics and Gynecology, vol. 179, no. 3 Pt 2, 1998, pp. S78-86.
Farmer RD, Lawrenson RA. Oral contraceptives and venous thromboembolic disease: the findings from database studies in the United Kingdom and Germany. Am J Obstet Gynecol. 1998;179(3 Pt 2):S78-86.
Farmer, R. D., & Lawrenson, R. A. (1998). Oral contraceptives and venous thromboembolic disease: the findings from database studies in the United Kingdom and Germany. American Journal of Obstetrics and Gynecology, 179(3 Pt 2), S78-86.
Farmer RD, Lawrenson RA. Oral Contraceptives and Venous Thromboembolic Disease: the Findings From Database Studies in the United Kingdom and Germany. Am J Obstet Gynecol. 1998;179(3 Pt 2):S78-86. PubMed PMID: 9753314.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Oral contraceptives and venous thromboembolic disease: the findings from database studies in the United Kingdom and Germany. AU - Farmer,R D, AU - Lawrenson,R A, PY - 1998/9/30/pubmed PY - 1998/9/30/medline PY - 1998/9/30/entrez KW - Biology KW - Contraception KW - Contraceptive Agents, Female--pharmacodynamics KW - Contraceptive Agents, Progestin--pharmacodynamics KW - Contraceptive Agents--pharmacodynamics KW - Contraceptive Methods--side effects KW - Desogestrel--pharmacodynamics KW - Developed Countries KW - Diseases KW - Embolism KW - Epidemiologic Methods KW - Europe KW - Family Planning KW - Germany KW - Gestodene--pharmacodynamics KW - Incidence KW - Levonorgestrel--pharmacodynamics KW - Measurement KW - Northern Europe KW - Oral Contraceptives, Combined--side effects KW - Oral Contraceptives--side effects KW - Research Methodology KW - Research Report KW - Retrospective Studies KW - Risk Factors KW - Studies KW - Thromboembolism KW - United Kingdom KW - Vascular Diseases KW - Western Europe SP - S78 EP - 86 JF - American journal of obstetrics and gynecology JO - Am J Obstet Gynecol VL - 179 IS - 3 Pt 2 N2 - OBJECTIVE: Three research articles published in late 1995 and early 1996 suggested that oral contraceptives containing either of the newer progestogens (gestodene or desogestrel) could be associated with an increased risk of venous thromboembolism. During the months after the initial publications, the results have been scrutinized with great care and further studies have been published. The findings of 2 recent database studies, 1 in the United Kingdom and 1 in Germany, are presented in this article. PATTERNS OF USE: The average age of users of combined oral contraceptives in Germany was 27 years, compared with 26 years in the United Kingdom. In Germany the use of gestodene-based products was lower than that in the United Kingdom. In the United Kingdom the users of desogestrel with 20 microg ethinyl estradiol (Mercilon) were older than the users of desogestrel with 30 microg ethinyl estradiol (Marvelon). CRUDE INCIDENCE: The crude incidence of venous thromboembolism in the UK study was 4.1 cases/10,000 woman-y exposure to combined oral contraceptives. In Germany it was 4.2 cases/10,000 woman-y. In Germany the rates among users of second-generation combined oral contraceptives were higher than those among users of third-generation products. The reverse was the case in the United Kingdom. In the United Kingdom the crude incidence rates were higher for the 20 microg estrogen desogestrel product than for the 30 microg product. CASE-CONTROL ANALYSIS: The adjusted odds ratios in the UK study did not show significant increases for desogestrel or gestodene compared with levonorgestrel products. There were inconsistencies in the results among centers in the 2 international studies (the World Health Organization and Transnational studies). In both there was a consistent inverse dose-response relationship with estrogen in all centers. CONCLUSION: The limitations of the observational studies are such that the hypothesis that the newer progestogens are more likely to cause venous thromboembolism cannot be proved. SN - 0002-9378 UR - https://www.unboundmedicine.com/medline/citation/9753314/Oral_contraceptives_and_venous_thromboembolic_disease:_the_findings_from_database_studies_in_the_United_Kingdom_and_Germany_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S00002937898005079 DB - PRIME DP - Unbound Medicine ER -