Scientists have long known that oral contraceptives, which contain the female hormones estrogen and progestogen, increase the likelihood of deep vein thrombosis of the leg and pulmonary embolism, but new studies in Denmark and the Netherlands determined that some pills are safer than others. Neither study received funding from any companies that make oral contraceptives.

Pills containing a second-generation progestogen — levonorgestrel or norgestrel — and a low dose of estrogen are safest, they concluded.

The overall risk of venous thromboembolism is low, perhaps three for 10,000 woman-years for women in general, said Dr. Ojvind Lidegaard, a professor of obstetrics and gynecology at the Rigshospitalet in Copenhagen, and lead author of one of two reports in the Aug. 14 online issue of BMJ. But older contraceptive pills double or triple that risk, and the newest generation of oral contraceptives increase the risk fourfold or fivefold, he said.

A first message from the studies is that “the risk when you are taking an oral contraceptive depends on both the estrogen dose and the progestogen dose, and the lower the dose, the less risk,” Lidegaard said.

Both studies found that the risk decreases with the length of time a woman takes a combination pill, and that progestogen-only pills and the use of hormone-releasing intrauterine devices are not associated with an increased risk.

The Dutch study, which compared 1,524 women under the age of 50 who had deep venous thromboembolisms with 1,760 women with no such history, found a fivefold increased risk in oral contraceptive users. The risk of an event was highest in the first three months of use and lowest with pills containing levonorgestrel.

Pills with equal doses of estrogen that contained the progestogen desogestrel had double the risk of the pills using levonorgestrel, the researchers found.

The Danish study of all women aged 15 to 49 from 1995 to 2005 found roughly the same association.

Women taking oral contraceptives had a fivefold increased risk of blood clots compared with nonusers, and the risk differed by the type of progestin. “The newer types of oral contraceptives containing drospirenone or cyproterone acetate are associated with an increased risk compared with oral contraceptives containing levonorgestrel,” Van Hylckama Vlieg says. Specifically, the researchers found that:

* Levonorgestrel boosted the risk of blood clots by nearly fourfold compared to nonusers.
* Gestodene boosted risk by 5.6 times.
* Drospirenone boosted risk 6.3 times.
* Cyproterone boosted risk 6.8 times.
* Desogestrel boosted risk 7.3 times.

The risk of blood clots was also associated with the level of estrogen in the pills, with higher estrogen dose linked with higher risk.

Switzerland’s medicines supervisor says it will analyse all birth control pills after a young woman suffered a lung embolism possibly linked to a contraceptive.

A spokesman for the Swiss Agency for Therapeutics (Swissmedic) told Swiss television late on Thursday that it had collected extensive research on various birth control pills and would come to a finding on their health effects in the autumn.

The announcement comes after a 16-year-old woman suffered a lung embolism that left her severely disabled. She had been taking Yasmin birth-control pills produced by Germany’s Bayer company.

Bayer contends the drug presents no more risk for venal thrombosis than other contraceptive pills.

“We assume that Smissmedic’s analysis concerning Yasmin will yield no new findings because Yasmin is one of the most well researched birth-control pills worldwide,” the company said.

Breast cancer and endometrial cancer are increased
Epidemiological studies consistently demonstrate an increased risk of breast cancer in women who used combined menopausal therapy. Largely confined to current or recent users, the risk increases with duration of use and exceeds that in women taking estrogen-only therapy. Endometrial cancer risks depend on the number of days that progestogens are included in the
combined therapy. When progestogens are taken fewer than 10 days per month, the risk of endometrial cancer is increased, but when progestogens are taken daily, the risk is similar to that in women who never used hormonal therapy. There was not sufficient evidence to conclude that hormonal therapy has a protective effect at any cancer site.

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Is NuvaRing to blame for Jackie Bozicev’s death? Her husband believes so.

Jackie died in December 2007. An autopsy showed she died of a blood clot that traveled from her pelvic area to her lungs. Her husband Rob was baffled. Up until that dreaded day, Jackie was seemingly healthy. She didn’t have a history of clots, nor did she smoke.

When doctors had no answers as to what caused the blood clot that led to his wifes death, Rob turned to Google and found what he believes is the culprit: NuvaRing, a birth control device inserted into the vagina monthly and removed after 3 weeks. A new ring must be inserted no more than 7 days later, according to NuvaRing’s Web site.

The device, made by Organon Pharmaceuticals (now owned by Schering-Plough) is touted as the first-of-its kind contraceptive with magazine ads proclaiming, “Let Freedom Ring.”

More than one million women use NuvaRing. Jackie started using the ring in May 2007, a month after giving birth to her second child.

“Jackie had no indication NuvaRing was any more dangerous than any other contraceptive,” says Carmen Scott, a lawyer representing the family in a civil lawsuit against the drugmaker.

All hormone-based contraceptives raise the risk of blood clots (which can lead to stroke and heart attack) but it is more common with some than others. The riskiest use third-generation hormones, like desogestrel (a similar compound is used in the ring).

Developed in the 1980s, the pills were intended to lessen non-serious side effects of the pill including acne and facial hair. Although largely ineffective in doing so and no better as birth control – which is acknowledged by the FDA – the pills remain on the market, says Mother Jones.

Research has consistently shown that these newer pills nearly double the risk of life-threatening blood clots compared to older forms of birth control pills. In 2007, Public Citizen, a watchdog group, petitioned the FDA to ban third-generation birth control pills. But the agency has yet to take action.

Blood clots can be particularly dangerous because they can travel through the veins and block blood flow at another location, causing a condition known as venous thromboembolism (VTE). Blood clots that travel to the lungs can cause pulmonary embolism, which is often fatal.

The FDA has received reports of 300 or more adverse events including stroke, heart attack, nonfatal blood clots and death, since NuvaRing’s approval in 2001, says Scott. More than 100 pending lawsuits attribute injuries to NuvaRing.

While those numbers may seem low, the pattern within them is relatively similar to those alleged against Johnson & Johnson’s – Ortho Evra, a skin patch approved for birth control. On that brand, 1,500 lawsuits were brought after more than 40 women died from blood clots and stroke.

The problem with both the patch and NuvaRing is one in the same: they deliver a constant stream of the active drug. By contrast, birth control pills enter the body through the digestive tract where much of the chemical is destroyed. Once the drug enters the patient’s blood, it lessens until the next pill is taken. Thus the body gets a rest from the drug whereas the patch/ring-wearer does not.

Injuryboard.com