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Contraception (Clinical) - Coggle Diagram

- - - - Highlights the variable effects on individuals
  - - - Ovarian
      - Endometrial
- - - - Especially in first 3 months of use as body adjusts to hormones
  - - - Venous thromboembolism
        
        Most commonly a DVT in leg
        
        Can travel to lungs
        
        Pulmonary embolism
        
        Life-threatening
        
        Combined Hormonal Oral Contraceptive risk: 5-12/10,000 per year
        
        Baseline risk: 2 cases/10,000 women per year
        
        2nd generation progestogens (e.g. Levonorgestrel): 5-7/10,000 per year
        
        3rd generation progestogens (e.g. Desogestrel, Gestodene): 9-12/10,000 per year
        
        Increased risk here from 2nd to 3rd Gen is not thought to be directly due to the progestogen itself
        
        Theory is 2nd Gen progesterone had some (possibly androgenic) properties that compensated for the estrogen prothrombotic effects
        
        When 3rd Gen was developed to have fewer androgenic properties
        
        Some of these anti-thrombotic benefits were lost
      - Arterial Thromboembolism
        
        Rarer than VTE
        
        Can lead to MI or stroke
        
        Strong personal or family history of DVT or PE is a contraindication
      - MOA
        
        Estrogen shifts haemostatic balance towards a prothrombotic state by affecting production of clotting and anti-clotting factors in the liver
    - - Overall Consensus: For women with low baseline risk of CVD and breast cancer, combined oral contraceptives are appropriate