Background: The type of progestogen in combined oral contraceptives (COC) became a focus of discussion in the mid-1990s as studies showed that progestogens gestodene and desogestrel were associated with an increased risk of venous thrombosis (VT) compared with the progestogen levonorgestrel. This led to a change in Dutch GP guidelines in 1998 which stated that physicians should preferably prescribe COC containing levonorgestrel.

Aims: The aim of this study was to investigate the trends in COC use after these guidelines were implemented. Trends in the use of other high risk progestogens drospirenone and cyproterone acetate (CPA) as well as the more recently developed progestogens dienogest and nomegestrol were also assessed.

Methods: Data from Dutch Foundation for Pharmaceutical Statistics (SFK) were used. We defined starters of COC as women who did not use hormonal contraceptives in the two years before starting COC. We assessed the proportion of starters of each progestogen from 2002-2016.

Results: The largest proportion of starters started with levonorgestrel (>60%) and this proportion increased throughout the years (Fig.1a). Simultaneously, gestodene and desogestrel starters showed a continuous decrease. Drospirenone and CPA starters showed a large decrease in 2012 onwards (Fig.1b). At the same time, there was a large increase in levonorgestrel starters. The smallest proportion of starters started with COC containing northisterone, norgestimate, dienogest or nomegestrol.

Conclusions: Following a change in Dutch GP guidelines, we observed a steady increase in levonorgestrel starters and a decrease in gestodene/desogestrel starters. In 2012-2013, France banned the use of CPA following 4 deaths from VT in women using this high risk COC. The decrease in CPA in Netherlands was most likely a consequence of this pill-scare. At the same time drospirenone was shown to increase VT risk and its usage dropped from 2012 onwards. Use of other progestogens, including newer ones, remained low.

[Figure 1a]

[Figure 1b]

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ISTH Congress Abstracts - https://abstracts.isth.org/abstract/trends-in-combined-oral-contraceptive-use-in-the-netherlands-2002-2016/