Which Oral Contraceptives Carry the Lowest Risk for Pulmonary Embolism, Ischemic Stroke, and Myocardial Infarction?

Globally, more than 100 million women use oral contraceptives (OCs) — but the complex relations between estrogens, progestins, and risk for venous and arterial thromboembolism remain to be teased out.

In an observational cohort study of 5 million French women (age range, 15–49) who took OCs between 2010 and 2012, 1800 pulmonary emboli, 1046 ischemic strokes, and 407 myocardial infarctions occurred. Compared with pills containing 30- or 40-µg ethinyl estradiol (EE), those containing 20-µg EE carried lower risk for pulmonary embolism (adjusted relative risk, 0.75), ischemic stroke (RR, 0.82), and myocardial infarction (RR, 0.56). Among all formulations studied, those containing 20-µg EE plus levonorgestrel had the lowest risk for pulmonary emb…