Pharmacotherapy Newsletter

Volume 2, Issue 5, 02/02/2010

Question

Does the dose of estrogen found in oral contraceptives (birth control pills) influence the risk for developing a clot or venous thromboembolism (deep vein thrombosis and/or pulmonary embolism)?

Answer

Oral contraceptives are used by millions of women worldwide. However, the risk for developing venous thromboembolism (VTE; deep vein thrombosis (DVT) and/or pulmonary embolism (PE)) has been a concern and subject of much debate.  This concern about oral contraceptives and risk for thrombosis started in 1961, with the first case report of VTE with the use of oral contraceptives (birth control pills) was reported in a nurse who suffered a PE shortly after the starting estrogen containing pills.(1)  After that, several other case-controlled and cohort studies consistently showed that oral contraceptive use (mainly with high estrogen doses of 50-150 mcg) were associated with an increased risk for VTE.(2,3,4)  This was thought to be primarily influenced by the dose of estrogen.  As such, the estrogen dose was...

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