3RD-GENERATION ORAL-CONTRACEPTIVES AND THROMBOEMBOLISM RISK

Recently, observational studies have suggested an increased risk of no nfatal venous thromboembolic complications in women using oral contrac eptives (OCs) containing the third-generation progestins, gestodene an d desogestrel. Because of the observational, rather than randomized, n ature of these trials, the clinical relevance of these findings is dif ficult to interpret. Each study included one or more potential sources of bias. In particular, cases came almost exclusively from hospitaliz ed patients with nonfatal venous thromboembolism, which represents onl y a minority of patients diagnosed with this condition according to cu rrent clinical practice. In the absence of a sound biologic rationale to explain the increased risk with third-generation OCs, and consideri ng the potential sources of bias within the current studies, an altern ative view argues against causality. Oral contraceptives remain safe a nd effective. Clearly, additional research is needed to determine the relationship between thromboembolic disease and the use of third-gener ation OCs. In the interim, women should be informed thoroughly with ob jective data on all risks associated with the use of OCs. (C) 1997 by The American College of Obstetricians and Gynecologists.