Third-generation OCs could be less safe than second-generation formulations

By Martha Kerr

SAN ANTONIO (Reuters Health) – Efforts to further reduce adverse risks associated oral contraceptive (OC) use by changing the progestogen component in the third-generation formulation have not reduced risk of stroke. Moreover, the newest pills confer a higher risk of venous thrombosis, Dutch researchers reported here Thursday at the American Stroke Association's 27th International Stroke Conference.

Dr. Ale Algra, of the University Medical Center, Utrecht, presented results of the RATIO Study, a multicenter study of 203 women between the ages of 18-49 with a first ischemic stroke. They were compared with 925 healthy, aged-matched controls randomly selected from the community.

OC use of any kind doubled the risk of stroke, Dr. Algra reported. Few women in the cohort were still using 1st generation OCs. They had a risk of stroke that was 1.7 times higher than non-OC users. Women taking second-generation OCs had a risk of stroke 2.4 times higher than nonusers, and those taking third-generation OCs had a risk of first ischemic stroke 2.2-fold higher than nonusers, Dr. Algra reported.

Women who smoked and used either second- or third-generation OCs had a fourfold higher risk of stroke than nonsmoking nonusers.

"There was no difference with regard to stroke or heart attack risk [between second- and third-generation OCs]," Dr. Algra commented, "but we do find an increased risk of venous thrombosis with the third-generation pill." The Dutch team found the latter risk in a study completed last year.

Dr. Algra commented that the progestogen component was changed from levonorgestrel in the second-generation formulation to either desogestrel or gestodene in the third-generation pill because these progestogens are associated with a more favorable lipid profile. The aim was to reduce risk of atherosclerosis, but it has not translated into reduced risk of stroke, he said.

"The picture is a bit broader than stroke," Dr. Algra told Reuters Health. "You also have to consider risk of venous thrombosis…My advice for physicians who are starting a woman for the first time on an oral contraceptive is to start with a second-generation."

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