ArticleBMJ (Clinical research ed.)2016
Low dose oestrogen combined oral contraception and risk of pulmonary embolism, stroke, and myocardial infarction in five million French women: cohort study.
Article in BMJ (Clinical research ed.), 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 74 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
74 citing papers in PubMed, 2 syntheses or guidelines pooled it, 196 citations in OpenAlex.
- Brazilian Guideline on Menopausal Cardiovascular Health - 2024.Arquivos brasileiros de cardiologia · 2024Guideline
- A Systematic Review and Meta-analysis of the Adverse Effects of Levonorgestrel Emergency Oral Contraceptive.Clinical drug investigation · 2020Pooled it
- Combined oral contraceptives containing estradiol valerate vs ethinylestradiol on coagulation: A randomized clinical trial.Acta obstetricia et gynecologica Scandinavica · 2022Trial
- Multicenter, phase III trials on the contraceptive efficacy, tolerability and safety of a new drospirenone-only pill.Acta obstetricia et gynecologica Scandinavica · 2019Trial
- Impact of Estetrol Combined with Drospirenone on Blood Coagulation and Fibrinolysis in Patients with Endometriosis: A Multicenter, Randomized, Open-Label, Active-Controlled, Parallel-Group Study.Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/HemostasisTrial
- Think before prescribing oral contraceptive pills - pulmonary embolism in an obese hypertensive woman: a case report.Annals of medicine and surgery (2012) · 2026Article
- Cardiovascular Safety of Hormonal Contraception: Method-Specific Risks and Clinical Implications.Medical sciences (Basel, Switzerland) · 2026Review
- Contraceptive use in France in 2012 and 2022: a descriptive analysis of two repeated nationwide cross-sectional studies.The Lancet regional health. Europe · 2025Article
- OSU-ERβ-12: a promising pre-clinical candidate selective estrogen receptor beta agonist.Scientific reports · 2025Article
- Oral contraceptives with progestogens desogestrel or levonorgestrel and risk of intracranial meningioma: national case-control study.BMJ (Clinical research ed.) · 2025Article
- Vasectomy Procedures on the Rise in France From 2010 to 2022.Perspectives on sexual and reproductive health · 2025Article
- Stroke and myocardial infarction with contemporary hormonal contraception: real-world, nationwide, prospective cohort study.BMJ (Clinical research ed.) · 2025Article
- Prolonged use of nomegestrol acetate and risk of intracranial meningioma: a population-based cohort study.The Lancet regional health. Europe · 2024Article
- Review
- The impact of female sex hormones on cardiovascular disease: from mechanisms to hormone therapy.Journal of geriatric cardiology : JGC · 2024Article
- Drug-induced coagulopathies: a real-world pharmacovigilance study using the FDA adverse event reporting system.Frontiers in pharmacology · 2024Article
- Brazilian Guideline on Menopausal Cardiovascular Health - 2024.Revista brasileira de ginecologia e obstetricia : revista da Federacao Brasileira das Sociedades de Ginecologia e Obstetricia · 2024Article
- COVID-19 Hospitalization in Solid Organ Transplant Recipients on Immunosuppressive Therapy.JAMA network open · 2023Article
- Impact of Cardiovascular Comorbidities on the Effectiveness and Safety of Bevacizumab in Older Patients with Metastatic Colorectal Cancer.Targeted oncology · 2023Article
- Associations of Oral Contraceptive Use With Cardiovascular Disease and All-Cause Death: Evidence From the UK Biobank Cohort Study.Journal of the American Heart Association · 2023Article
14 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
8 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo assess the risk of pulmonary embolism, ischaemic stroke, and myocardial infarction associated with combined oral contraceptives according to dose of oestrogen (ethinylestradiol) and progestogen.
designObservational cohort study.
settingData from the French national health insurance database linked with data from the French national hospital discharge database.
participants4 945 088 women aged 15-49 years, living in France, with at least one reimbursement for oral contraceptives and no previous hospital admission for cancer, pulmonary embolism, ischaemic stroke, or myocardial infarction, between July 2010 and September 2012.
main outcome measuresRelative and absolute risks of first pulmonary embolism, ischaemic stroke, and myocardial infarction.
resultsThe cohort generated 5 443 916 women years of oral contraceptive use, and 3253 events were observed: 1800 pulmonary embolisms (33 per 100 000 women years), 1046 ischaemic strokes (19 per 100 000 women years), and 407 myocardial infarctions (7 per 100 000 women years). After adjustment for progestogen and risk factors, the relative risks for women using low dose oestrogen (20 µg v 30-40 µg) were 0.75 (95% confidence interval 0.67 to 0.85) for pulmonary embolism, 0.82 (0.70 to 0.96) for ischaemic stroke, and 0.56 (0.39 to 0.79) for myocardial infarction. After adjustment for oestrogen dose and risk factors, desogestrel and gestodene were associated with statistically significantly higher relative risks for pulmonary embolism (2.16, 1.93 to 2.41 and 1.63, 1.34 to 1.97, respectively) compared with levonorgestrel. Levonorgestrel combined with 20 µg oestrogen was associated with a statistically significantly lower risk than levonorgestrel with 30-40 µg oestrogen for each of the three serious adverse events.
conclusionsFor the same dose of oestrogen, desogestrel and gestodene were associated with statistically significantly higher risks of pulmonary embolism but not arterial thromboembolism compared with levonorgestrel. For the same type of progestogen, an oestrogen dose of 20 µg versus 30-40 µg was associated with lower risks of pulmonary embolism, ischaemic stroke, and myocardial infarction.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.