Contraceptive pill and thrombosis risk assessment

Upon reports of increased risk for the most recent, third-generation pills (which contain desogestrel or gestodene or drospirenone as a progestin), many gynaecologists have started prescribing a series of preliminary analyses to women who request the pill, with the mistaken conviction of being able to select candidates for safe hormonal contraception. It is important to remember, though, that the risk is really minimal and any potential obstacle to hormonal contraception should be considered only for women with predetermined risk factors. It is for this reason that routinely prescribing generic blood tests, generic coagulation tests and specific tests for thrombosis, including genetic tests, before prescribing or during a course of oestroprogestinic contraceptives, is not recommended and could be well considered unnecessary.

Advice from Altroconsumo

- Choosing a contraceptive is a personal issue based on the preferences of an individual or couple. It requires quality information and occasionally good counselling in an appropriate environment and with qualified professionals. The family clinic is the most appropriate facility.
- Check with your doctor that your choice of contraception is compatible with your health. There are medical criteria, updated by the WHO, that allow you to evaluate the pros and cons of different contraceptive choices.
- Even the choice of the pill is important. There are various products that the doctor can prescribe based on different criteria (efficiency, safety, side effects, price).
- A good medical history, that includes age, weight, blood pressure, possible diabetes or smoking and family history of thromboembolism is the best way to evaluate the risk of thrombosis and guide a decision.
- Taking an oestroprogestinic pill is not recommended in the first weeks after child delivery and during breastfeeding. These are periods in which it is possible to use a pill that only contains progestin.

Questions to your doctor

If the doctor prescribes a test, medication or surgery, remember that “Doing more does not mean doing better” and ask:

  • Do I really need this exam/treatment?
  • What are the risks?
  • Are there simpler and safer alternatives?
  • What happens if I don’t take this exam/treatment?

Download the document and bring it to your doctor to discuss

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In collaboration with

ANDRIA – the Italian Association for the Promotion of appropriate care in Obstetrics, Gynaecology and Perinatal Medicine

The information available in this tool is a clue to talk to your doctor or trusted professional. It is not a substitute for information and advice that you can get by contacting them directly.

To find out more and to know the sources used, consult the Altroconsumo website and the Choosing Wisely Italy website