Venous and arterial thrombosis during oral contraceptive use in Libyan women
Ali M. Sarrar, Ali M. Rafieda, Donia H. Shaglouf, Waad M. Elshwain
Abstract
Birth control, known as contraception, can be defined as the use of medicines, devices, or surgery to prevent pregnancy. Hormonal contraceptive steroids are available mainly as oral preparations, although preparations for subcutaneous implantation and vaginal insertion have also been developed. There are two types of oral contraceptive pills: combined estrogen-progesterone and progesterone. The birth control pill is the most commonly prescribed form of contraception. Millions of women all over the world have used OCs for many years and Multiple prospective and case-control studies have shown that the currently available OCs are still associated with venous and arterial thrombosis, and that’s what prompted us to do this study. OCs are a risk factor for myocardial infarction especially when there are other cardiovascular risk factors, such as, hypertension, diabetes, hypercholesterolemia, and obesity, and these risk factors increase with age. In addition, numerous alterations in blood proteins promote venous thrombosis, falling into one of three categories: increased procoagulants; decreased anticoagulants; and decreased fibrinolytics. A questionnaire was handed to patients (women aged 18 to 49) of gynecology clinics in the city of Misrata. The results showed that oral contraceptives are the most commonly used, and that contraceptives containing drospirenone plus ethenyl estradiol such as Yasmine are the most commonly used followed by levonorgestrel such as Microval. Most women used oral contraceptives under specialized medical supervision. However, many women who used oral contraceptives faced multiple side effects, most notably menstrual disorders. The results also showed that many women suffered from previous thrombo-vascular diseases, most notably CVDs and obstructive pulmonary diseases, which often appeared at an age of more than 30 years. Routine screening of all women for genetic risk factors before the prescription of an OC is not cost-effective. In addition, it would deprive a large number of women of the safest method of contraception.
Keywords
References
- Shukla A, Jamwal R. Adverse effect of combined oral contraceptive pills. Asian Journal of Pharmaceutical and Clinical Research. 2017; 10(1): 17-21. doi: 10.22159/ajpcr.2017.v10i1.14565
- Uddin MM, Rahman MM, Rafi IK, Khandaker MS. Health problems in Bangladesh: A struggle for equitable and accessible healthcare. Mediterranean Journal of Medicine and Medical Sciences. 2025; 1(1): 1-7. doi: 10.5281/ zenodo.15606021
- Paul SK. Assessment of knowledge and attitude of adverse drug reactions among healthcare professionals in Bangladesh. Mediterranean Journal of Pharmacy and Pharmaceutical Sciences. 2025; 5(2): 70-78. doi: 10.5281/ zenodo.15275065
- Asmamaw DB, Negash WD. Magnitude of unmet need for family planning and its predictors among reproductive age women in high fertility regions of Ethiopia: Evidence from Ethiopian Demographic and Health Survey. BMC Women's Health. 2022; 22(1): 408. doi: 10.1186/s12905-022-01982-w
- Vandenbroucke JP, Rosing J, Bloemenkamp KW, Middeldorp S, Helmerhorst FM, Bouma BN, et al. Oral contraceptives and the risk of venous thrombosis. The New England Journal of Medicine. 2001; 344(20): 1527-1535. doi: 10.1056/NEJM200105173442007
- Cooper DB, Patel P. Oral contraceptive pills. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025. PMID: 28613632.
- Trussell J, Aiken ARA, Micks E, Guthrie KA. Efficacy, safety, and personal considerations. In: Hatcher RA, Nelson AL, Trussell J, Cwiak C, Cason P, Policar MS, et al., Eds. Contraceptive technology. 21st Ed., New York, Ayer Company Publishers, Incorporated, 2018. ISBN: 1732055602.
- Ahmed EM, Hamad MNM, Gafar SE. Effect of oral contraceptives on coagulation parameters among Sudanese women in Khartoum state. EC Gynaecology. 2020; 9: 01-05. doi: Nil.
- Bennell K, White S, Crossley K. The oral contraceptive pill: a revolution for sportswomen? British Journal of Sports Medicine. 1999; 33(4): 231-238. doi: 10.1136/bjsm.33.4.231
- Baird DT, Glasier AF. Hormonal contraception. The New England Journal of Medicine. 1993; 328(21): 1543-1549. doi: 10.1056/NEJM199305273282108
- Sondheimer SJ. Oral contraceptives: Mechanism of action, dosing, safety, and efficacy. Cutis. 2008; 81(1S): 19-22. PMID: 18338654.
- Curtis KM, Jatlaoui TC, Tepper NK, Zapata LB, Horton LG, Jamieson DJ, et al. U.S. selected practice recommendations for contraceptive use, 2016. MMWR. Recommendations and Reports. 2016; 65(4): 1-66. doi: 10.15585/mmwr.rr6504a1
- Vandenbroucke JP, Rosing J, Bloemenkamp KW, Middeldorp S, Helmerhorst FM, Bouma BN, et al. Oral contraceptives and the risk of venous thrombosis. The New England Journal of Medicine. 2001; 344(20): 1527-1535. doi: 10.1056/NEJM200105173442007
- Korver T, Goorissen E, Guillebaud J. The combined oral contraceptive pill: What advice should we give when tablets are missed? British Journal of Obstetrics and Gynecology. 1995; 102(8): 601-607. doi: 10.1111/j.1471-0528. 1995.tb11396.x
- van Vlijmen EFW, Wiewel‐Verschueren S, Monster TBM, Meijer K. Combined oral contraceptives, thrombophilia and the risk of venous thromboembolism: a systematic review and meta‐analysis. Journal of Thrombosis and Haemostasis. 2016; 14(7): 1393-1403. doi: 10.1111/jth.13349
- Inman WH, Vessey MP, Westerholm B, Engelund A. Thromboembolic disease and the steroidal content of oral contraceptives. A report to the Committee on Safety of Drugs. British Medical Journal. 1970; 2(2507): 203-209. doi: 10.1136/bmj.2.5703.203
- De Bruijn SF, Stam J, Vandenbroucke JP. Increased risk of cerebral venous sinus thrombosis with third-generation oral contraceptives. Cerebral Venous Sinus Thrombosis Study Group. Lancet. 1998; 351(9113): 1404. doi: 10.1016 /s0140-6736(05)79442-3
- Mansourati J, Da Costa A, Munier S, Mercier B, Tardy B, Ferec C, et al. Prevalence of factor V Leiden in patients with myocardial infarction and normal coronary angiography. Thrombosis and Haemostasis. 2000; 83(6): 822-825. PMID: 10896232.
- McDaid A, Logette E, Buchillier V, Muriset M, Suchon P, Pache TD, et al. Risk prediction of developing venous thrombosis in combined oral contraceptive users. PLoS One. 2017; 12(7): e0182041. doi: 10.1371/journal.pone. 0182041
- Elfituri AA, Sherif FM, Elmahaishi MS, Chrystyn H. Two hormone replacement therapy (HRT) regimens for Middle-Eastern postmenopausal women. Maturitas. 2005; 52(1): 52-59. doi: 10.1016/j.maturitas.2004.12.003
- Elfituri AA, Sherif FM, Chrystan H, Elmahaishi MS. 18-month progestrogen-only contraception during breast-feeding in Libyan women. Pan Arab Medical Journal. 2006; 28-32. doi: Nil.
- Serfaty D. Update on the contraceptive contraindications. Journal of Gynecology Obstetrics and Human Reproduction. 2019; 48(5): 297-307. doi: 10.1016/j.jogoh.2019.02.006
- Pomp ER, Le Cessie S, Rosendaal FR, Doggen CJ. Risk of venous thrombosis: obesity and its joint effect with oral contraceptive use and prothrombotic mutations. British Journal of Hematology. 2007; 139(2): 289-296. doi: 10.1111/j.1365-2141.2007.06780.x
- Engbers MJ, van Hylckama Vlieg A, Rosendaal FR. Venous thrombosis in the elderly: Incidence, risk factors and risk groups. Journal of Thrombosis and Haemostasis. 2010; 8: 2105-2112. doi: 10.1111/j.1538-7836.2010. 03986.x
- van Hylckama Vlieg A, Helmerhorst FM, Vandenbroucke JP, Doggen CJM, Rosendaal FR. The venous thrombotic risk of oral contraceptives, effects of oestrogen dose and progestogen type: Results of the MEGA case-control study. British Medical Journal. 2009; 339: b2921. doi: 10.1136/bmj.b2921
- No author's list. Ischaemic stroke and combined oral contraceptives: Results of an international, multicentre, case-control study. WHO Collaborative Study of Cardiovascular Disease and Steroid Hormone Contraception. Lancet. 1996; 348(9026): 498-505. PMID: 8757151.
- Strandberg J, Gade IL, Palarasah Y, Gram JB, Kristensen SR, Sidelmann JJ. Combined oral contraceptives may activate the contact system in healthy women. Research and Practice in Thrombosis and Haemostasis. 2023; 7(2): 100118. doi: 10.1016/j.rpth.2023.100118
- Thomson JM, Poller L, Bocaz JA, Barja P, Bonnar J, Daly L, et al. A multicentre study of coagulation and haemostatic variables during oral contraception: Variations with four formulations. An International Journal of Obstetrics and Gynecology. 1991; 98(11): 1117-1128. doi: 10.1111/j.1471-0528.1991.tb15364.x
- de Visser MC, Rosendaal FR, Bertina RM. A reduced sensitivity for activated protein C in the absence of factor V Leiden increases the risk of venous thrombosis. Blood. The Journal of the American Society of Hematology, 1999; 93(4): 1271-1276. PMID: 9949170.
- Deguchi H, Bouma BN, Middeldorp S, Lee YM, Griffin JH. Decreased plasma sensitivity to activated protein C by oral contraceptives is associated with decreases in plasma glucosylceramide. Journal of Thrombosis and Haemostasis. 2005; 3(5): 935-938. doi: 10.1111/j.1538-7836.2005.01335.x
- Rosendaal FR. Oral contraceptives and screening for factor V Leiden. Thrombosis and Haemostasis. 1996; 75(3): 524-525. PMID: 8701424.
- Trenor III CC, Chung RJ, Michelson AD, Neufeld EJ, Gordon CM, Laufer MR, et al. Hormonal contraception and thrombotic risk: a multidisciplinary approach. Pediatrics. 2011; 127(2): 347-357. doi: 10.1542/peds.2010-2221
- Ernst E. Oral contraceptives, fibrinogen and cardiovascular risk. Atherosclerosis 1992; 93(1-2): 1-5. doi: 10.1016/ 0021-9150(92)90194-l
- Conard J, Gompel A, Pelissier C, Mirabel C, Basdevant A. Fibrinogen and plasminogen modifications during oral estradiol replacement therapy. Fertility and Sterility. 1997; 68(3): 449-453. doi: 10.1016/s0015-0282 (97)00220-3
- Hall KS, Trussell J. Types of combined oral contraceptives used by US women. Contraception. 2012; 86(6): 659-665. doi: 10.1016/j.contraception.2012.05.017
- Baratloo A, Safari S, Rouhipour A, Hashemi B, Rahmati F, Motamedi M, Forouzanfar M, Haroutunian P. The risk of venous thromboembolism with different generations of oral contraceptives; A systematic review and meta-analysis. Archives of Academic Emergency Medicine. 2014; 2(1): 1-11. PMID: 26495334.
- Díez-Villanueva P, Jiménez-Méndez C, Bonanad C, García-Blas S, Pérez-Rivera Á, Allo G, García-Pardo H, Formiga F, Camafort M, Martínez-Sellés M, Ariza-Solé A, Ayesta A. Risk Factors and Cardiovascular Disease in the Elderly. Reviews in Cardiovascular Medicine. 2022; 23(6): 188. doi: 10.31083/j.rcm2306188
- Bloemenkamp KW, Rosendaal FR, Helmerhorst FM, Büller HR, Vandenbroucke JP. Enhancement by factor V Leiden mutation of risk of deep-vein thrombosis associated with oral contraceptives containing a third-generation progestagen. Lancet 1995; 346(8990): 1593-1596. doi: 10.1016/s0140-6736(95)91929-5
- Abdallah KA. Anticardiolipin antibodies in Sudanese women with recurrent miscarriage: A hospital-based study from Kosty, White Nile. Mediterranean Journal of Medical Research. 2025; 02: 6-10. doi: 10.5281/zenodo. 15132712
- Teal S, Edelman A. Contraception selection, effectiveness, and adverse effects a review. JAMA. 2021; 326(24): 2507-2518. doi: 10.1001/jama.2021.21392
- Elfituri AA, Elmahaishi MS, MacDonald TH, Sherif FM. Health education in the Libyan Arab Jamahiriya: assessment of future needs. Eastern Mediterranean Health Journal. 2006; 12(Suppl 2): S147-56. PMID: 17361686.
- Sherif FM. Education and practice of pharmacy in Libya. Mediterranean Journal of Pharmacy and Pharmaceutical Sciences. 2022; 2(3): 1-2. doi:10.5281/zenodo.7115078
- Alssageer M, Hassan A, Rajab M. Consumers' view, expectation and satisfaction with community pharmacy services. Mediterranean Journal of Pharmacy and Pharmaceutical Sciences. 2021; 1(4): 90-98. doi: 10.528/zenodo. 5806191
- Elfituri AA, Sherif FM. Novel clinical pharmacy practice: extended role and improved competencies. Mediterranean Journal of Pharmacy and Pharmaceutical Sciences 2022; 2(1): 1-3. doi: 10.5281/zenodo.6397651
Submitted date:
09/27/2025
Reviewed date:
11/30/2025
Accepted date:
12/04/2025
