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[Sexual abstinence or thrombosis? Comment on the controversy regarding the "third generation pill"] Enthaltsamkeit oder Thrombose? Stellungnahme zur Kontroverse um "Pille der dritten Generation".
FORTSCHRITTE DER MEDIZIN. 1995 Nov 30; 113(33):18, 20.In October 1995 the WHO published the alarming results of an international study about oral contraceptives (OCs) and the risk of venous thrombosis stating that with the use of the third generation of OCs or micropills containing gestodene and desogestrel the risk increases twofold compared with OCs containing other gestagens. However, the Zurich discussion group, composed of German and Swiss hormone researchers, declared that this statement should be taken with a grain of salt. The study reported that 3 cases of thrombosis occur for 100,000 woman years when no OCs are used. When OCs without the above two gestagens are used the incidence of thrombosis increases to 8 cases/100,000 woman years. With the use of these micropills the incidence rose to 17 cases/100,000. The experts interpretation of the differentials was that the common risk factors for thrombosis (obesity, smoking, age, and duration of OC use) were not sufficiently taken into consideration. The original higher dose OCs already produced side effects early on, such as thrombosis, stroke, and heart infarction. Therefore, in the late 1980s the introduction of the new generation of OCs with lower doses seemed to be a welcome solution. The micropill, Femovan by Schering, was put on the market containing .03 mg of ethinyl estradiol (EE) and .075 mg of gestodene, a synthetic, very effective gestagen. The Organon Company introduced another preparation (Marvelon) that contained the same dose of EE and .15 mg of desogestrel. The considerable attention to the putative higher risk of thrombosis posed by these agents was not shared by the European Drug Commission, which did not see any reason for removal of these OCs from the market. The third generation OCs also provide benefits: reduction of bleeding anomalies and cardioprotective effects. Even the increased thrombosis risk is significantly lower than the thrombosis risk posed by pregnancy, delivery, and puerperium.