The oral contraceptive pill – especially the Diane 35- was in the news again. However, this is a bit strange: there is nothing new about the information that third and fourth generation oral contraceptives have an increased risk of thrombosis compared to the risk conveyed by second generation oral contraceptives. Because the desired effects of the older and newer generation pills are similar (not getting pregnant, preventing or curing acne) there is limited, if any, reason to prescribe the newest and more expensive pills. See also the recent comment by Helmerhorst and Rosendaal in the BMJ. However, still 160.000+ (Diane 35) 500.000 (third generation) women take these newer pills. Since thrombosis risk might be highest in the first few months, it is unclear whether these women all should switch to the safer second generation oral contraceptives. But for women who get their first prescription, a second generation oral contraceptive the best way to go (also according the Dutch GP guidelines).
A lot of the research on this topic has been executed by my colleagues from both the MEGA study and the RATIO study. Want to learn more about the pill controversy, please listen this episode of Argos, a Dutch radio programme.
In case you are wondering: the absolute risk of thrombosis in young women is low, even when using a newer generation oral contraceptives. But all added risk that can be avoided should be avoided by you in dialogue with your GP!
bob siegerink 