Does the risk of unplanned pregnancy outweigh the risk of VTE from hormonal contraception?

Educate your patient

I favor the approach of providing as much data as possible. Patients may read the black box warning in the package inserts for drospirenone-containing pills or the norelgestromin patch, find news sources that inaccurately report risk to garner the most compelling headline, or stumble across plaintiff’s lawyers advertising lawsuits for drospirenone-containing pills, the contraceptive ring, and the patch. I can best counter confusion or misinformation by providing accurate information and putting possible risks into perspective up front. I now explain that the risk for VTE may be higher with certain pills, the ring, and the patch, but there just aren’t enough high-quality data to be certain. I also explain that risk may mean different things for different patients, based on medical history and previous experiences. I have found that my patients appreciate the full disclosure.

Overall, the benefits of combined hormonal contraception with all methods outweigh the risk of VTE. In addition, issues related to switching contraceptive methods may increase the risk of an unplanned pregnancy. In 1995, when the United Kingdom warned that desogestrel pills carried an increased risk of VTE but were still “safe,” the incidence of unplanned pregnancies and abortions increased.^2,11 The data regarding the risk of VTE associated with drospirenone, the patch, and the ring should not be an impetus for sweeping generalizations, but rather an opportunity to educate our patients (and ourselves) and to further individualize care.