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Question 4#

The combined oral contraceptive pill is associated with an increased risk of developing VTE.

Which of the following factors has been demonstrated to reduce the risk of VTE?

A. <50 µg of ethinyl estradiol
B. First-generation progestins
C. Oral contraceptive use of <1 year
D. Age >39 years

Correct Answer is A


Correct Answer: A

VTE is the most common vascular complication of combined oral contraception (COC) use. Although the risk is higher than in nonusers, the absolute risk is low and much less than the risk of VTE in pregnancy and early postpartum.

Studies have demonstrated that the risk of VTE is reduced by use of lower doses of ethinyl estradiol (<50 µg) and second-generation progestins (levonorgestrel). The risk of VTE is actually highest in the first year of COC use. The risk of VTE rises sharply after the age of 39 years in women taking COC. Women who smoke also have a greater risk. 


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  2. van Hylckama Vlieg A, Helmerhorst FM, Vandenbroucke JP, et al. The venous thrombotic risk of oral contraceptives, effects of oestrogen dose and progestogen type: results of the MEGA case-control study. BMJ. 2009;339:b2921.
  3. de Bastos M, Stegeman BH, Rosendaal FR, et al. Combined oral contraceptives: venous thrombosis. Cochrane Database Syst Rev. 2014; (3):CD010813.
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