Contraception Orale Et Risque Vasculaire

Oral contraception is available since the early 60's and has allowed a considerable improvement of woman's health, and condition. Regardless of its availability, 1/3 of all pregnancies remains undesired, and is terminated in half of the cases. This situation is clearly unacceptable, and request a better availability of contraceptive drugs and methods. The major drawback of combined oral contraception containing an oral estrogen is the increased risk of DVT in particular when the potent estrogen ethinylestradiol is used. This is related to the pharmacologic resistance to protein C induced by the estrogenic action on the liver. This in turn increases the risk of DVT by 3-8 fold. This risk is even more obvious when the progestin associated to EE belongs to the 3rd and 4th generation. The overall risks is however very low in absolute number, is far less than the risk observed in pregnancy, and in the post partum period. Emphasis should be placed on prevention, by informing women of the potential symptoms suggesting a veinous thrombosis or a pulmonary embolism, and by recognizing women at risk in case of familial risk of thrombosis, obesity, age... These measures are far more important than the restriction of certain methods since contraception remains in great need.