Update: contraceptive pill and associated risks

There is evidence that contraception had been practiced since the third century BC, when Hippocrates already disseminated that the wild carrot seed was able to prevent pregnancy. Since then, other forms of prevention have been discovered and practiced by women and men: natural plants, vaginal tampons and condoms made with animal viscera.

Modernity allowed the development of cheaper and more durable protection, such as the vulcanized rubber condom (1844) and the diaphragm (1870).

It was only in 1950 that norethisterone, a synthetic hormone similar to progesterone, was synthesized, and in 1960 norethynodrel, combined with synthetic estrogen, gave birth to the first combined contraceptive pill (CCP).

Since then, the contraceptive pill has changed the world, especially for women.

Despite this, silent risks have been unmasked, showing that the use of CCP is not only joy as it was dreamed.

It has already been shown that CCP use is associated with an increased risk of arterial thrombosis, ie, acute myocardial infarction (AMI) or ischemic stroke.

A Cochrane study (2015) reviewed studies published since the 1960s to estimate the risk of AMI or stroke in users, non-users, at different doses and types of contraceptives.

• It was found that the risk of AMI or stroke is 1.6 times higher in women who used CCP;

• The data show that the risk is higher for pills with more than 50 μg of estrogen;

• Concerning the risk of venous thrombosis, it is suggested that the pill containing levonorgestrel and 30 μg of estrogen is the safest oral form of hormonal contraception.

Most recently (2017), a study evaluated whether women with medical conditions associated with increased risk of thrombosis would be at the same risk of using estrogen-containing contraceptives if they used progesterone-only contraceptives (POC).

• It was found that of the evidences identified, there was no increase in the odds of venous or arterial events with the use of most POCs.

Another review study (2016) evaluated whether the use of CCP modifies the risk of AMI, stroke, cerebral venous thrombosis (CVT) and venous thromboembolism (VT) in obese women and evaluated the relationship between BMI and VT.

• They concluded that there is limited evidence (level II-2) about the risk of stroke and AMI: both CCP use and higher BMI increase the risk of VT.

Regarding thromboembolic events in women with type 1 or type 2 diabetes using hormonal contraception, the absolute risk of thromboembolism was found to be low but, in order to avoid the teratogenic effects of hyperglycemia, the use of intrauterine contraceptives And subdermal.

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BAYER. Breve História da Contracepção. 2017. Disponível em: <https://pharma.bayer.com.br/pt/areas-terapeuticas/saude-de-a-a-z/contracepcao/metodos-contraceptivos/historia-contracepcao/index.php>. Acesso em: 06 ago. 2017.

Roach RE, Helmerhorst FM, Lijfering WM, Stijnen T, Algra A, Dekkers OM. Combined oral contraceptives: the risk of myocardial infarction and ischemic stroke. Cochrane Database of Systematic Reviews 2015, Issue 8. Art. No.: CD011054. DOI: 10.1002/14651858.CD011054.pub2.

TEPPER, Naomi K. et al. Progestin-only contraception and thromboembolism: A systematic review. Contraception, [s.l.], v. 94, n. 6, p.678-700, dez. 2016. Elsevier BV. http://dx.doi.org/10.1016/j.contraception.2016.04.014.

HORTON, Leah G. et al. Combined hormonal contraceptive use among obese women and risk for cardiovascular events: A systematic review. Contraception, [s.l.], v. 94, n. 6, p.590-604, dez. 2016. Elsevier BV. http://dx.doi.org/10.1016/j.contraception.2016.05.014.

O’BRIEN, Sarah H. et al. Hormonal Contraception and Risk of Thromboembolism in Women With Diabetes. Diabetes Care, [s.l.], v. 40, n. 2, p.233-238, 29 nov. 2016. American Diabetes Association. http://dx.doi.org/10.2337/dc16-1534.