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Meta-Analysis
. 2018 Jul;25(10):1042-1052.
doi: 10.1177/2047487318774847. Epub 2018 May 10.

Association between progestin-only contraceptive use and cardiometabolic outcomes: A systematic review and meta-analysis

Marija Glisic  1 , Sara Shahzad  2 , Stergiani Tsoli  3   4 , Mahmuda Chadni  5 , Eralda Asllanaj  1 , Lyda Z Rojas  1 , Elizabeth Brown  5 , Rajiv Chowdhury  2 , Taulant Muka  1 , Oscar H Franco  1
Affiliations
Meta-Analysis

Association between progestin-only contraceptive use and cardiometabolic outcomes: A systematic review and meta-analysis

Marija Glisic et al. Eur J Prev Cardiol. 2018 Jul.

Abstract

Aims The association between progestin-only contraceptive (POC) use and the risk of various cardiometabolic outcomes has rarely been studied. We performed a systematic review and meta-analysis to determine the impact of POC use on cardiometabolic outcomes including venous thromboembolism, myocardial infarction, stroke, hypertension and diabetes. Methods and results Nineteen observational studies (seven cohort and 12 case-control) were included in this systematic review. Of those, nine studies reported the risk of venous thromboembolism, six reported the risk of myocardial infarction, six reported the risk of stroke, three reported the risk of hypertension and two studies reported the risk of developing diabetes with POC use. The pooled adjusted relative risks (RRs) for venous thromboembolism, myocardial infarction and stroke for oral POC users versus non-users based on the random effects model were 1.06 (95% confidence interval (CI) 0.70-1.62), 0.98 (95% CI 0.66-1.47) and 1.02 (95% CI 0.72-1.44), respectively. Stratified analysis by route of administration showed that injectable POC with a RR of 2.62 (95% CI 1.74-3.94), but not oral POCs (RR 1.06, 95% CI 0.7-1.62), was associated with an increased risk of venous thromboembolism. A decreased risk of venous thromboembolism in a subgroup of women using an intrauterine levonorgestrel device was observed with a RR of 0.53 (95% CI 0.32-0.89). No effect of POC use on blood pressure was found, but there was an indication for an increased risk of diabetes with injectable POCs, albeit non-significant. Conclusions This systematic review and meta-analysis suggests that oral POC use is not associated with an increased risk of developing various cardiometabolic outcomes, whereas injectable POC use might increase the risk of venous thromboembolism.

Keywords: Progestogen; cardiometabolic risk; contraception; hypertension; myocardial infarction; progesterone; progestin-only pill; stroke; type 2 diabetes; venous thromboembolism; women.

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Figures

Figure 1.
Figure 1.
Flow diagram of studies included in the review.
Figure 2.
Figure 2.
The association between progestin-only contraceptive (POC) use and risk of venous thromboembolism by route of administration. The summary estimates presented were calculated using random effects and fixed effects models. 95% confidence interval (CI) (bars). P comes from Q statistics.
Figure 3.
Figure 3.
The association between oral progestin-only contraceptive (POC) use and risk of myocardial infarction by route of administration. The summary estimates presented were calculated using random effects and fixed effects models. 95% confidence interval (CI) (bars). P comes from Q statistics.
Figure 4.
Figure 4.
The association between oral progestin-only contraceptive (POC) use and risk of stroke by route of administration. The summary estimates presented were calculated using random effects and fixed effects models. 95% confidence interval (CI) (bars). P comes from Q statistics.
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