NLM Director’s Comments Transcript
Small, Manageable Contraceptive Risks: 07/30/2012

Greetings from the National Library of Medicine and MedlinePlus.gov

Regards to all our listeners!

I'm Rob Logan, Ph.D. senior staff National Library of Medicine for Donald Lindberg, M.D, the Director of the U.S. National Library of Medicine.

Here is what's new this week in MedlinePlus.

The risks of a heart attack and stroke among women who use contraceptives are elevated — but small and potentially manageable, finds a comprehensive study from Denmark recently published in the New England Journal of Medicine.

The research, a rare study of an entire population (not a sample) of Danish women for a 14 year period, found slightly elevated risks of stroke and heart attacks occurred among women who took oral contraceptives, vaginal ring contraceptives, and a transdermal patch compared to peers who did not take prescription contraceptives.

The study found no statistically distinguishable differences among a range of estrogen-progestin based oral contraceptives (also known as birth control pills). In other words, the study did not find one type of prescription contraceptive pill was associated with a higher risk of heart attack or stroke than others.

The relative risk of heart attack and stroke was somewhat higher among women who used vaginal ring and transdermal patch contraceptives. However, the study of more than 1.6 million Danish women ages 15-40 (from 1995-2009), found the elevated risk of heart attacks and strokes among vaginal ring and transdermal patch users was not statistically distinguishable from taking birth control pills.

Overall, the study found the absolute risk, or additional heart attacks and strokes attributable to all assessed contraceptives occurred in about 1 to 2 per 10,000 Danish women each year.

An editorial that accompanied the study suggests (and we quote): ‘These are small numbers. For an individual women, the probability of an event is quite small’ (end of quote).

The editorial adds the number of participants in the Danish study eclipses the scope of similar research in the U.S. and other nations. Hence, the Danish study’s findings are seen as more comprehensive and generalizeable than previous research. While the types of assessed hormonal contraceptives are listed in a table within the study, they do not necessarily cover all the prescription contraceptives available in the U.S. or other nations.

Overall, the editorial suggests (and we quote): ‘women, their physicians, and the public should be reassured not only by the Danish study but by the vast body of evidence from epidemiologic studies of hormonal contraception that have been done over the past five decades’ (end of quote).

The editorial adds the health risks associated with prescription contraceptive use might be managed with some routine medical consultation and supervision. The author writes (and we quote) ‘the research shows that the small risk could be minimized and perhaps eliminated by abstinence from smoking and by checking blood pressure, with avoidance of hormonal contraceptive use if blood pressure is raised’ (end of quote).

The editorial concludes the array of estrogen-progestin contraceptives assessed in the study (and we quote): ‘whether delivered orally or by means of the patch or the ring - are safe enough’ (end of quote).

MedlinePlus.gov provides an overview of prescription estrogen and progestin oral contraceptives as well as vaginal ring and transdermal patch products within the ‘drugs and supplements’ section. For example, the oral contraceptive page warns smoking increases the risk of serious side effects from taking oral contraceptives, such as blood clots, stroke, and heart attack.

The page provides basic background information about the safe use of oral contraceptives, including their compatibility with a range of other medications and supplements, such as St. John’s Wort.

The page notes some of the less serious side effects from taking oral contraceptives include: nausea, vomiting, constipation, and acne. The page adds some of the more serious side effects from taking oral contraceptives include: dizziness, fever, double vision, and unusual bleeding.

Additional information is provided about storing oral contraceptives, and what to do in case of an overdose. The combined ingredients within brand names of prescription oral contraceptives (available in the U.S.) are listed.

There is similar information in separate pages about vaginal ring and transdermal patch contraceptives.

To find MedlinePlus.gov’s estrogen and progestin (oral contraceptive) information, type ‘oral contraceptive’ in the search box on MedlinePlus.gov’s home page. To find MedlinePlus.gov’s vaginal ring and transdermal patch contraceptive information, type ‘vaginal ring’ and ‘transdermal patch’ in the search box on MedlinePlus.gov’s home page.

MedlinePlus.gov also has a health topic page about birth control with extensive links to additional information. To find MedlinePlus.gov’s birth control health topic page, type ‘birth control’ in the search box on MedlinePlus.gov’s home page, then, click on ‘birth control (National Library of Medicine).’

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A disclaimer – the information presented in this program should not replace the medical advice of your physician. You should not use this information to diagnose or treat any disease without first consulting with your physician or other health care provider. I want to take the opportunity to wish you a very happy holiday season and a healthy New Year. The National Library of Medicine and the 'Director's Comments' podcast staff, including Dr. Lindberg, appreciate your interest and company – and we hope to find new ways to serve you in 2012.

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