Combined oral contraceptive pill and venous thromboembolism

“…the prescribing of combined oral contraceptive pills to women with a body mass index >30 kg/m 2 , and particularly those with multiple risk factors for cardiovascular disease, is becoming difficult to justify. ” An increased risk of venous thromboembolism (VTE) was the first serious side effect identified with the combined oral contraceptive pill (COC) in the 1960s. This was quickly realised to be due to the estrogen content of the COC and this has been the main driver behind reductions in estrogen dose seen in the last 50 years [1]. However, in 1995, several studies were published that suggested that COCs containing the progestogens desogestrel and gestodene (‘third-generation’ COCs) increased the risk of VTE more than ‘second-generation’ COCs (containing levon orgestrel). This created a widespread pill-scare, which has never fully been resolved, despite the incongruity that progestogen-only contraceptives do not increase VTE risk and newer evidence showing that prescriber bias and many confounding factors were not taken into account [2].