Combined Oral Contraceptives: Thromboembolism Risk and Hormonal Effects on Fluid Retention

Combined oral contraceptives (COCs) are a popular option for family planning, utilized by millions of women worldwide. These medications contain estrogens and progestins, and while they are effective in preventing pregnancy, their use is not without risks and side effects. One of the most discussed risks is venous thromboembolism (VTE), a potentially serious complication that must be considered when prescribing these hormonal medications.

Diving into Thromboembolic Risk and Other Side Effects

The risk of venous thromboembolism associated with COCs has been extensively studied. Evidence shows that the use of COCs increases the risk of VTE compared to non-users. This risk varies depending on the type of progestin and the dose of estrogens in the formulation. For instance, contraceptives containing desogestrel, gestodene, or drospirenone present a significantly higher risk of VTE compared to those containing levonorgestrel [1]. Additionally, the risk of arterial thrombotic events, such as myocardial infarction and ischemic stroke, also increases, especially with higher doses of estrogens [2].

Beyond thromboembolic risk, COCs can cause other hormonal side effects, such as fluid retention, changes in body weight, and mood alterations. These effects can vary significantly among users and depend on individual factors such as genetic predisposition and lifestyle [3]. In women with pre-existing conditions like obesity, cardiovascular risk may be even higher, suggesting that products containing only progestins could be a safer alternative [4].

Conclusions

The choice of a contraceptive method should be an individualized process that considers the specific risks and benefits for each patient. Combined oral contraceptives offer an effective option for pregnancy prevention, but it is crucial to evaluate the risk of thromboembolism and other side effects before prescribing. The discussion between the physician and the patient should include a detailed assessment of personal and family risk factors, as well as consideration of available alternatives. Ongoing research and the development of new formulations, such as those containing natural estrogens, may provide safer options in the future [5].

Referencias

• [1] Risk of venous thromboembolism from use of oral contraceptives containing different progestogens and oestrogen doses: Danish cohort study, 2001-9.
• [2] Combined oral contraceptives: the risk of myocardial infarction and ischemic stroke.
• [3] Contraception Selection, Effectiveness, and Adverse Effects: A Review.
• [4] Obesity and contraceptive use: impact on cardiovascular risk.
• [5] Estetrol/Drospirenone: A Review in Oral Contraception.

Created 6/1/2025