Tepper Naomi K, Nguyen Antoinette T, Whiteman Maura K, Curtis Kathryn M
Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States.
Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States.
Contraception. 2025 May 30:110978. doi: 10.1016/j.contraception.2025.110978.
Evidence is limited on whether the use of progestin-only contraception (POC) is associated with the risk of thrombosis. Our objective was to update an earlier systematic review on POC and thrombosis risk.
We searched for articles that examined risk of venous thromboembolism (VTE) (e.g., deep venous thrombosis or pulmonary embolism) or arterial thromboembolism (ATE) (e.g., myocardial infarction or stroke) among women with thrombogenic conditions or characteristics or in the general population using POC, compared with women using nonhormonal or no contraception, published during February 1, 2016 through November 30, 2022. We also included articles from a previous systematic review, with articles published through January 2016. We assessed quality for each study and certainty of evidence for all outcomes.
Thirty-three articles met inclusion criteria; one was good quality, 20 were fair quality, and 12 were poor quality. Seven articles were newly identified, and 26 were included in the previous review. Risk of VTE, but not ATE, was generally elevated with depot medroxyprogesterone acetate (DMPA) use among women with certain thrombogenic conditions or characteristics (e.g., diabetes or postpartum) and women in the general population. Risks of VTE and ATE were generally not elevated with use of other POC, including levonorgestrel intrauterine devices, implants, or progestin-only pills.
Evidence suggests that risk of VTE, but not ATE, is increased with DMPA use compared with nonuse among women with certain thrombogenic conditions and women in the general population. Evidence does not suggest increased risk of VTE or ATE with use of other POC. While several studies examined thrombosis risk with POC use and thrombogenic conditions or characteristics, data are limited for individual conditions or characteristics and no evidence was identified for most conditions. The certainty of evidence is low or very low for all outcomes.
Use of DMPA might increase the risk of VTE among women with medical conditions associated with thrombosis and among women in the general population. Evidence does not suggest an increased risk of thrombosis with other POC. Further study is needed on safety of POC use by women with thrombogenic conditions.
关于仅使用孕激素避孕法（POC）是否与血栓形成风险相关的证据有限。我们的目的是更新一项关于POC与血栓形成风险的早期系统评价。
我们检索了2016年2月1日至2022年11月30日期间发表的文章，这些文章研究了患有血栓形成相关疾病或特征的女性或普通人群中使用POC的女性发生静脉血栓栓塞（VTE）（如深静脉血栓形成或肺栓塞）或动脉血栓栓塞（ATE）（如心肌梗死或中风）的风险，并与使用非激素避孕法或未避孕的女性进行比较。我们还纳入了之前系统评价中的文章，这些文章发表至2016年1月。我们评估了每项研究的质量以及所有结局的证据确定性。
33篇文章符合纳入标准；1篇质量良好，20篇质量中等，12篇质量较差。7篇文章是新发现的，26篇被纳入之前的评价。在患有某些血栓形成相关疾病或特征（如糖尿病或产后）的女性以及普通人群中，使用醋酸甲羟孕酮长效避孕针（DMPA）通常会增加VTE风险，但不会增加ATE风险。使用其他POC，包括左炔诺孕酮宫内节育器、植入剂或单纯孕激素避孕药，VTE和ATE风险通常不会增加。
有证据表明，与未使用DMPA的女性相比，患有某些血栓形成相关疾病的女性和普通人群中使用DMPA会增加VTE风险，但不会增加ATE风险。没有证据表明使用其他POC会增加VTE或ATE风险。虽然有几项研究探讨了使用POC与血栓形成相关疾病或特征的血栓形成风险，但针对个体疾病或特征的数据有限，且大多数疾病未发现相关证据。所有结局的证据确定性都很低或非常低。
对于患有与血栓形成相关疾病的女性和普通人群，使用DMPA可能会增加VTE风险。没有证据表明其他POC会增加血栓形成风险。需要对患有血栓形成相关疾病的女性使用POC的安全性进行进一步研究。
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