Combined birth control pills linked to increased risk of blood clots in obese women – ScienceDaily

Obese women who use oral contraceptives that contain estrogen and a progestogen have a 24-fold increased risk of developing venous thromboembolism (VTE) compared to non-obese women who do not use these drugs, according to a review published today in ESC heart failure, a journal of the European Society of Cardiology (ESC).

The author of the study, Professor Giuseppe Rosano from IRCCS San Raffaele Pisana, Rome, Italy, said: “It is well known that both obesity and contraceptives containing estrogen are risk factors for VTE. Despite this, obese women continue to receive these drugs.” Scientific evidence indicates that obesity and combined oral contraceptives have a synergistic effect on VTE risk and this should be taken into account in prescribing decisions. Progestogen-only products including pills, IUDs or implants, are a safer alternative to the combined pill in overweight women. “

This review article highlights the latest evidence on the independent effects of obesity and contraceptives and their synergistic effects on VTE risk and provides clinical recommendations. VTE refers to a blood clot in a vein and includes two life-threatening conditions: deep vein thrombosis and pulmonary embolism.

The World Health Organization estimates that the global prevalence of obesity almost tripled between 1975 and 2016 – with 15% of adult women being obese. The risk of VTE increases progressively with body mass index (BMI) and is more than twice as high in obese women as in non-obese women. Obesity has the greatest impact on VTE women under the age of 40, who have a five-fold increased risk compared to non-obese women. Professor Rosano noted: “The particularly high risk in obese women under 40 is important, as many at this age are looking for contraception.”

Combined oral contraceptives are associated with an increased risk of VTE, with users having a three to seven-fold increased risk of VTE compared to non-users. In contrast, progestogen-only products are not associated with an increased risk of VTE.

The combination of overweight/obesity and the use of combined oral contraceptives increases the likelihood of blood clots in women of childbearing potential. For example, a large population-based study found that being overweight and obese are associated with a 1.7-fold and 2.4-fold increased risk of VTE, respectively. However, in combined pill users, the risk of VTE was 12 times higher in overweight women and 24 times higher in obese women – compared to non-users of normal weight.

Professor Rosano said: “Obese women using contraceptives are vulnerable to VTE and should take steps to limit their other predisposing factors to cardiovascular disease, for example by quitting smoking and increasing their physical activity.”

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Materials provided by European Society of Cardiology. Note: Content can be edited for style and length.

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