From the Guidelines
Ethinylestradiol/levonorgestrel-containing oral contraceptives are recommended over drospirenone for patients concerned about venous thromboembolism (VTE) risk due to their lower VTE risk profile. The most recent and highest quality study 1 supports this recommendation, indicating that levonorgestrel-containing pills carry approximately half the VTE risk of those containing drospirenone.
Key Points to Consider
- The absolute risk difference is small but significant, with approximately 6-7 cases per 10,000 women-years for levonorgestrel combinations versus 9-12 cases per 10,000 women-years for drospirenone combinations 1.
- Drospirenone's antimineralocorticoid and antiandrogenic properties may increase thrombogenic potential, contributing to the higher VTE risk 1.
- The estrogen component (ethinylestradiol) contributes to VTE risk in both formulations, but the progestin type significantly modifies this risk 1.
- When prescribing, individual patient factors such as personal or family history of thrombosis, presence of other risk factors, and patient preferences regarding other contraceptive benefits should be considered 1.
Patient-Specific Considerations
- Patients with a history of thrombosis or at high risk of VTE may benefit from levonorgestrel-containing pills due to their lower VTE risk profile.
- Patients who prioritize acne control or PMDD management may still consider drospirenone-containing pills, despite the slightly higher VTE risk, as they may offer advantages in these areas 1.
- A comprehensive medical history and measurement of blood pressure are essential before prescribing COCs, and patient eligibility self-screening tools can help expand COC access 1.
From the FDA Drug Label
COCs containing DRSP may be associated with a higher risk of venous thromboembolism (VTE) than COCs containing levonorgestrel or some other progestins. Based on presently available information on DRSP-containing COCs with 0.03 mg ethinyl estradiol (that is, Yasmin), DRSP-containing COCs may be associated with a higher risk of venous thromboembolism (VTE) than COCs containing the progestin levonorgestrel or some other progestins.
The risk of Venous Thromboembolism (VTE) is higher with Drospirenone compared to Levonorgestrel.
- Drospirenone may be associated with a higher risk of VTE than COCs containing Levonorgestrel or some other progestins 2.
- The risk of VTE with Drospirenone is compared to Levonorgestrel in several studies, with some showing a higher risk and others showing no increase in risk 2.
- It is essential to consider the risks and benefits of a Drospirenone-containing COC in light of a woman's risk of a VTE before initiating use 2.
From the Research
Comparison of Ethynloestradiol/Levonorgestrel and Drospirenone for VTE Risk
- The risk of venous thromboembolism (VTE) is higher for combined oral contraceptives (COCs) containing drospirenone compared to those containing levonorgestrel 3, 4, 5.
- COCs with ethinyl-estradiol (EE) and levonorgestrel are associated with a lower VTE risk than those with EE and drospirenone 3, 4.
- The VTE risk for transdermal COC, such as vaginal ring or patch, is as high as that for COC of 3rd or 4th generation, which includes those containing drospirenone 3.
- Progestogen-only contraceptive methods, including oral levonorgestrel-only contraceptives, do not increase VTE risk significantly 3, 4, 6.
Recommendations for Contraception in Patients with VTE Risk
- In patients with a history of VTE and/or a known thrombophilic defect, COCs are contraindicated, but progestagen-only contraceptives can be safely used 3, 4, 6.
- Oral desogestrel- or levonorgestrel-only contraceptives, intrauterine device, and etonogestrel implants are recommended for women with a history of VTE and/or suffering from thrombophilia 4.
- Screening for thrombophilia is not indicated in every woman with the wish for contraception, but should be restricted to certain cases, such as women with a positive history for VTE or with close relatives suffering from VTE in younger than 50 years 4.