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  • Title: The case for a lower dose pill. Assessing the impact of estrogen dose.
    Author: Brown S, Cropfield O.
    Journal: ORGYN; 1995; (2):36-9. PubMed ID: 12319251.
    Abstract:
    Every Dane has an identity number, allowing one to follow persons despite name and/or address changes. Every Dane discharged from a hospital has at least one diagnosis that is stored in the national patient register. This allows researchers to find women in a specific age group who have had a cerebral thrombosis, regardless of residence. Dr. Ojvind Lidegaard, a Danish gynecologist, has conducted a retrospective case control study to clarify the relationship between oral contraceptives (OCs) and the risk of cerebral thrombosis. He analyzed data on all Danish women aged 15-44 who had experienced a cerebral thrombosis between 1985 and 1989. After conducting a multivariate analysis, he found that OCs with 50 mcg estrogen had an odds ratio of 2.9 for cerebral thromboembolic attack, those with 30-40 mcg estrogen had an odds ratio of 1.8, and progestogen-only OCs had an odds ratio of 0.9. He concluded that the lower the content of estrogen in OCs, the lower the risk of cerebral thrombosis. He estimated the relative risk for the new 20 mcg OCs to be 1.2-1.3. His study found that the most significant contributor to risk of cerebral thrombosis is age. The odds increase by about 10 times between age 20 and age 40. Cigarette smoking alone increases the risk by 50%. At the University of Pisa in Italy, women using OCs with 30 mcg estrogen had higher levels of fibrinogen and fibrinopeptide A (blood coagulating factors) than did those using OCs with 20 mcg estrogen. Neither OC affected the anticoagulant antithrombin III, however. In fact, the 20 mcg OC induced no changes in hemostatic parameters. These studies show that estrogen contents of OCs determine the risk of cerebral thrombosis. Dr. Lidegaard claims that women can use low-dose OCs until age 50, assuming they do not smoke. He believes these OCs can be safely used by smokers until they reach age 35-40. Women who should not use OCs include those who have had a thrombosis or have high blood pressure or coagulation disorders.
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