2024-03-25 18:00:00
Hormonal contraceptives have been increasingly shunned by women in recent years, as well as by prescribers. The cause, in particular, is their deleterious effects on cardiovascular health.
According to Public Health France, sales of oral contraceptives are in constant decline, 12% in 10 years. Estrogen-progestin contraceptives (combined oral contraceptive pill or COCP) are particularly impacted with a drop of 33%, the share of progestin-only pills is still increasing.
Why are these numbers decreasing?
The cause of this distrust? The cardiovascular risks posed by these pills. In 2012, the High Authority for Health warned: “all COCPs lead to an increased risk of venous thromboembolism, myocardial infarction and ischemic stroke. This is why any prescription of COCP must be preceded by a search for personal or family risk factors for thrombosis.”
In the crosshairs, 3rd and 4th generation pills. In a document updated in June 2023 available on the website of the Ministry of Health, we learn that “the National Agency for the Safety of Medicines and Health Products (ANSM) carried out an information campaign among professionals of health (doctors, midwives, pharmacists) so that the 1st and 2nd generation pill is systematically preferred. The use of 3rd and 4th generation pills should be the exception, not the rule.”
Risk factors and contraindications
What are these risk factors and do they concern all women? The Eligyn* survey, conducted by Ipsos for the pharmaceutical manufacturer, Gedeon Richter and whose results were recently published, aims to establish the prevalence of cardiovascular risk factors (FDRCV) and contraindications in women of age. procreate.
2,500 were invited to indicate the risk factors and contraindications they presented in the following lists:
FRDCVs:
- Be over 35 years old
- Suffer from obesity
- Smoking more than 15 cigarettes per day
- Being affected by dyslipidemia (high cholesterol and/triglycerides)
- Suffering from controlled dyslipidemia
- Suffering from type 1 diabetes
- Suffering from type 2 diabetes
- Suffering from migraines without aura (this neurological disorder which precedes the headache).
Contraindications:
- High blood pressure
- Uncontrolled dyslipidemia
- Suffering from type 1 diabetes for 20 years or more
- Suffering from migraines with aura
- Suffering from thrombophilia
- Have been personally affected by a myocardial infarction (MI) or stroke or venous thromboembolic disease (VTVE)
- Have at least one first-degree family history (parents, brother, sister, children) of MI or stroke before age 55 (men) or age 65 (women)
- Have at least one family history of 1st degree VTE – phlebitis or thrombosis or embolism before the age of 55.
The rule: if a woman has at least one contraindication or at least two risk factors, then an estrogen-progestin oral contraceptive cannot be prescribed.
38% of women at cardiovascular risk
According to the results of the survey, 52% of the women surveyed use a method of contraception, including 41% hormonal contraception. Among them, 17% use estrogen-progestin contraception.
More than a third of women, or 38% of respondents, had a contraindication (29%) and/or arterial and venous vascular risk factors (19%). For them, the prescription of an estrogen-progestin oral contraceptive was prohibited.
“There is a synergy of FRDCVs. For example, a patient who suffers from migraine and takes the pill increases her cardiovascular risk; if she also smokes, this is further multiplied. All FRDCV potentiates the risk,” explains Dr. Maitro-Mantelet, obstetrician-gynecologist at Cochin hospital in Paris.
Necessary awareness
However, nearly 2 out of 5 women using contraception say they have never received information regarding FDRCV from their doctor. Among them, 28% have arterial and venous cardiovascular risk factors…
“We need to raise awareness among patients but also among doctors, a first consultation to prescribe contraception takes time,” concludes Dr. Maitrot-Mantelet.
“We must ask the patient regarding her FDRCV, ask her mother, her grandmother to find out if there have been phlebitis, pulmonary embolisms, heart attacks, strokes in the family. Once we have eliminated the contraindications and CVRFs, we must explain to patients all the possible options. Some practitioners do not have, or do not take this necessary time. It is a long consultation and requires therapeutic education”
*Eligyn study, “Prevalence of cardiovascular risk in women”, survey carried out online by Ipsos for Gedeon Richter among 2,500 women representative of the French population, aged 16 to 55, from November 14 to 16, 2022.
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