Venous Thromboembolism Risk Assessment

Introduction to Venous Thromboembolism Risk

Venous thromboembolism (VTE) risk is associated with the use of combined oral contraceptives (COCs), with a risk of 3-9 per 10,000 woman-years, compared to a baseline risk of 1-5 per 10,000 woman-years in non-users, as noted by the American Academy of Dermatology and the American College of Cardiology 1, 2

Standard EE/drospirenone COCPs have a VTE risk of approximately 10 per 10,000 woman-years, according to the American College of Cardiology and the American Academy of Dermatology 2
Drospirenone-containing COCs may have a slightly higher risk of VTE compared to levonorgestrel-containing formulations, with approximately 10 per 10,000 woman-years vs. 3-9 per 10,000 woman-years, as noted by the American Academy of Dermatology and the American College of Cardiology 1, 2
The risk of VTE is associated with both low (≤30 μg) and moderate (>30-50 μg) doses of ethinyl estradiol, and the progestin component also influences VTE risk, as reported by the American Academy of Dermatology 2

Lower estrogen doses (≤30 μg) may have less impact on blood pressure compared to higher doses, as recommended by the American College of Cardiology for patients with hypertension concerns 1
Drospirenone, a fourth-generation progestin, has anti-mineralocorticoid effects that may help reduce blood pressure in some women, as suggested by the American Academy of Dermatology 1, 3, 2
The properties of different progestins are summarized in the following table:

Progestin	Generation	Androgenic Activity	Anti-androgenic Properties
Norgestimate	Third	Minimal	Peripheral anti-androgenic properties
Norgestrel	Second	Higher	None
Drospirenone	Fourth	Anti-androgenic	Anti-mineralocorticoid properties

Common contraindications for all COCs include age ≥35 years with smoking, history of deep vein thrombosis or pulmonary embolism, ischemic heart disease, history of cerebrovascular accident, migraines with aura, and active viral hepatitis or severe liver disease, as noted by the American Academy of Dermatology 3, 2
Baseline blood pressure measurement, follow-up at 1-3 months after initiation, and assessment for improvement at 3 months are recommended, with consideration of combination with other hair loss treatments if response is inadequate, as suggested by the American Academy of Dermatology 2

Women with polycystic ovary syndrome (PCOS), lipid disorders, or cardiovascular risk factors may benefit from norgestimate due to its beneficial effects on lipid metabolism and minimal effects on carbohydrate metabolism, as noted by the American Academy of Dermatology 3, 2
Norgestimate-containing COCs are preferred for women requiring contraception with a history of acne or PCOS, while norgestrel-containing COCs should be avoided, as recommended by the American Academy of Dermatology 3, 2
Four combined oral contraceptives are FDA-approved for the treatment of acne, including Norgestimate/ethinyl estradiol, Norethindrone acetate/ethinyl estradiol/ferrous fumarate, Drospirenone/ethinyl estradiol, and Drospirenone/ethinyl estradiol/levomefolate, as noted by the American Academy of Dermatology 3
Loryna (drospirenone) is also FDA-approved for the treatment of PMDD, and has demonstrated efficacy for emotional and physical symptoms of PMDD in randomized controlled trials, as reported by the American Academy of Dermatology 2