Abstract
Hormonal contraceptives (estrogen/progestogen combination) are burdened by an increased risk of thrombosis. Newer progestogens (third and fourth generation) in combination with estrogen are particularly thrombogenic. The partial effect pattern of progestogens seems to explain this. Thrombogenic risk seems to occur in combination with ethinyl estradiol and to a lesser extent with estradiol or estradiol valerate. The partial androgenic effect of a progestogen, if present, counteracts the stimulation of the protein synthesis of the liver and thus the factors of hemostasis and fibrinolysis. Indeed, second-generation progestogens such as levonorgestrel, with a more prominent pattern of androgenic partial effects, reduce the estrogen-driven protein synthesis in the liver and therefore the thrombotic/antithrombotic balance, leading to an increased thrombotic risk, except for second-generation progestogens such as levonorgestrel. Also, the type and the dose of the estrogens and in addition the oral and non-oral routes do have an influence. Similar thrombotic risk changes were not seen with progestogen-only preparations (POPs), which do not cause an increase in thrombotic risk. Because of the special partial effect pattern of progesterone and dydrogesterone, there is no undue thrombotic risk with these progestogens, even in combination with estrogens.
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© 2015 International Society of Gynecological Endocrinology
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Schindler, A.E. (2015). Hormonal Contraceptives: Progestogen and Thrombotic Risk. In: Fauser, B.C.J.M., Genazzani, A.R. (eds) Frontiers in Gynecological Endocrinology. ISGE Series. Springer, Cham. https://doi.org/10.1007/978-3-319-09662-9_8
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DOI: https://doi.org/10.1007/978-3-319-09662-9_8
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