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Common combination oral contraceptive (COC) options and risks

Common combination oral contraceptive (COC) options and risks
Progestin Progestin Progestin relative
VTE risk*[1]		 Progestin absolute
VTE risk[1-3]		 Typical formulations
(progestin mg/ethinyl estradiol mcg)
Generation Androgenicity
Norethisterone 1 Weak androgen 2.6 7 Loestrin (0.5/20); Estrostep (1.0/30)
Levonorgestrel 2 Weak androgen 2.4 6 Alesse (0.1/20); Levora (0.15/30)
Norgestimate 2 to 3 Neutral or weak androgen 2.5 6 Tri-Sprintec (0.18/35); Ortho-Cyclen (0.25/35)
Gestodene 3 Neutral 3.6 11 Sunya (0.075/20) [UK]; Femodene (0.075/30) [UK]
Desogestrel 3 Neutral 4.3 14 Mircette (0.15/20); Desogen (0.15/30)
Drospirenone 4 Antiandrogen 4.1 13 Yaz (3/20); Yasmin (3/30)
Cyproterone acetate – Antiandrogen 4.3 14 Diane (2/35) [UK]
COC: combination oral contraceptive; VTE: venous thromboembolism; UK: United Kingdom.
* Relative VTE risk is compared with patients who are not using oral contraceptives.
¶ Extra cases of VTE per 10,000 women treated with COCs per year.
References:
  1. Vinogradova Y, Coupland C, Hippisley-Cox J. Use of combined oral contraceptives and risk of venous thromboembolism: nested case-control studies using the QResearch and CPRD databases. BMJ 2015; 350:h2135.
  2. Stegeman BH, de Bastos M, Rosendaal FR, et al. Different combined oral contraceptives and the risk of venous thrombosis: systematic review and network meta-analysis. BMJ 2013; 347:f5298.
  3. Martin KA, Anderson RR, Chang RJ, et al. Evaluation and treatment of hirsutism in premenopausal Women: An Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2018; 103:1233.
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