Safety fears remain over 'third generation' pill use

By KATHERINE HOBY AND REUTERS

Women taking so-called third-generation contraceptive pills are more likely to suffer clots in veins than those taking older types but the risk is small, says a Dutch study.

A debate about the safety of the newer pill has raged since 1995 when a health scare triggered by three European studies led thousands of women to abandon what had previously been the most popular oral contraceptive.

The use of the pills in Britain dropped from 54 per cent to 14 per cent in women aged 15 to 49.

Since 1996, the use of third-generation pills in New Zealand has more than halved.

Seven deaths in New Zealand from 1992 to 1998 were linked to the new pills, which were marketed as Marvelon, Mercilon, Minulet and Femodene.

Five of the deaths occurred in two years - 1997 and 1998.

At the time women flooded GPs and family planning clinics seeking advice on the risk associated with oral contraceptive use.

Some women stopped using the pill when it was revealed that some types put users at greater risk of developing potentially fatal blood clots.

Doctors were concerned about this, saying that there would be an increase in unwanted pregnancies and abortions.

Critics then suggested that the methods used in the overseas studies were flawed.

In a bid to settle the debate, Jeanet Kemmeren and colleagues at the University Medical Centre Utrecht, in the Netherlands, pooled the results of all the studies they could find up to 1995 that assessed the blood-clotting risk of pills containing third-generation progestogens.

They checked for any bias in the trials before deciding, in an article published in the British Medical Journal, that there was an increased risk - although small - compared with second-generation pills.

The researchers also found the risk was higher among first-time users, where the chance of clotting was 3.1 times greater using third-generation contraceptives than second-generation pills.

But the study said the dangers remained slight, the excess risk for users of third-generation contraceptives over second-generation working out at 1.5 per 10,000 women years.

GPs council chairman Dr Philip Rushmer said the study, while interesting, merely confirmed earlier information on third-generation pills.

"This study confirms that taking third generation carries a small risk over second generation," he said.

"It is but a small risk and as long as women are given an informed choice on the matter it is solely for them to decide."

He said the key factors when deciding on a pill were family history of blood clots, and whether the woman was a smoker or overweight.