In a recent large-scale Danish study published by The BMJ, researchers have identified a slight increase in the risk of blood clots, specifically venous thromboembolism (VTE), among women using non-steroidal anti-inflammatory painkillers (NSAIDs) alongside hormonal contraception. The study, which spanned from 1996 to 2017 and included 2 million women aged 15 to 49, revealed that the risk was more pronounced in those using combined oral contraceptives containing third or fourth generation progestins.
While the absolute risk of developing a serious blood clot remains low, especially in women using high-risk hormonal contraception, the researchers emphasize the importance of informing women about this potential drug interaction. Given the widespread use of both hormonal contraception and NSAIDs, the study suggests that healthcare professionals should advise women accordingly.
NSAIDs, including ibuprofen, diclofenac, and naproxen, have been previously linked to blood clots. However, little was known about whether their use influences the risk of venous thromboembolism in otherwise healthy women using hormonal contraception. To address this gap, the researchers analyzed national medical records, tracking first-time diagnoses of VTE among women with no history of blood clots, cancer, hysterectomy, or fertility treatment.
Hormonal contraception was categorized into high, medium, and low risk based on their association with VTE. High-risk options included combined estrogen and progestin patches, vaginal rings, and pills containing specific hormone doses. Medium-risk contraception encompassed other combined oral contraceptives and the medroxyprogesterone injection, while progestin-only tablets, implants, and intrauterine devices were classified as low or no risk.
The study, covering over 500,000 women using NSAIDs alongside hormonal contraception, revealed that diclofenac showed the strongest association with VTE compared to ibuprofen and naproxen. Over a 10-year monitoring period, the absolute risk of VTE events was higher in women using NSAIDs, especially when combined with high-risk hormonal contraception.
Though this observational study cannot establish causation, the researchers adjusted for various influential factors, and the associations persisted after further analysis. The findings prompt consideration of alternatives to NSAIDs for analgesia in women using hormonal contraception, particularly high-risk options. Healthcare authorities and regulators are urged to incorporate these findings into safety assessments, and clinicians are advised to explore alternatives to diclofenac when NSAID treatment is necessary.
In conclusion, this nationwide study sheds light on the potential risks associated with the concurrent use of two commonly prescribed drug classes for otherwise healthy women. It underscores the importance of informed decision-making and alternative approaches for women requiring both hormonal contraception and regular NSAID use.
