Newspaper headlines have suggested a new alert about the safety of combined oral contraceptives. This is incorrect. There is no change in the advice given earlier this year", says the Department of Health.
This announcement follows the publication in the British Medical Journal (1999;319:820) of a report of increased incidence of venous thromboembolism over the period 1977 to 1995. Dr Lene Mellemkjær (department of medicine, Aarhus University hospital, Denmark) and colleagues say that this rise appears to coincide with use of third generation oral contraceptives and supports the hypothesis that third generation pills increase the risk of venous thromboembolism.
They qualify this opinion, saying: "Our result must, however, be interpreted with caution: the numbers are small, and it is based on data that are subject to misclassification."
In an accompanying editorial, (1999;319:795), Dr Paul O'Brien (senior medical officer in clinical effectiveness, St Charles' hospital, London) says that all the hypotheses put forward in criticism of the studies done on third generation oral contraceptives and venous thromboembolism have failed to explain the increased risk. However, although changes in incidence rates provide supporting data, causation requires stronger evidence, he says. His conclusion is: "It is not that third generation contraceptives are unsafe - it is just that we have something safer."
The advice given by the Department of Health in April was that the pill is a safe and effective form of contraception and the choice of product is a matter for the woman and her health practitioner to make in the light of full information on the risk.