Introduction
Contraception is an important part of the life of any modern woman. In 2013 88% of sexually active women reported using at least one contraceptive method (Teal & Edelman, 2021). The use of oral contraceptives and long-acting reversible contraceptive (LARC) methods account for more than 23% together (Kavanaugh & Jerman, 2018). In the last two decades, there has been an upward trend in the use of LARC, including intrauterine devices (IUDs) (Kavanaugh & Jerman, 2018). This is, on the one hand, due to the development and improvement of LARC technologies, and on the other hand, due to the growing concern of women about the health impact of oral contraceptives.
Unfortunately, at present, female contraceptive methods have several side effects, including the development of a tendency to thrombosis and the appearance of blood clots. Therefore, doctors constantly monitor the statistics of the occurrence of adverse effects and strive to develop more reliable and safe methods of contraception. This work aims to study the relationship between the practice of contraception and the occurrence of blood clots. The main issue is to estimate if healthy women aged 25-40 who use oral contraceptive pills have a greater risk of thrombosis versus women who use IUDs for contraception within a 5-year span.
Background of the Studies
Articles “Contraception selection, effectiveness, and adverse effects” 2021 and “Systematic review and meta-analysis of the association of combined oral contraceptives on the risk of venous thromboembolism” 2018 were used for this paper. Both of these articles are a meta-analysis of the relationship between oral contraceptives and thrombosis, based on a large amount of research on this topic. These papers analyze about a hundred studies on female contraception published in the last 20 years.
These studies examined the effect of contraceptives on healthy women who do not have concomitant diseases. The review included studies of various durations, including observations for 5-7 years, which is the period of interest. However, the articles do not offer clear information about the age category of the women on whom the study was conducted. The reports provide information about adolescents and women under 21 separately, concentrating on women from 21 and older (Teal & Edelman, 2021; Oedingen et al., 2018). The upper age limit of the studied women is 50 years old (Teal & Edelman, 2021; Oedingen et al., 2018). Thus, the age range of the studied women is broader than in this work.
Article “Contraception selection, effectiveness, and adverse effects” describes the difference in the effect of oral contraceptives (COCs) and hormonal and non-hormonal LARS on thrombosis. This comparison is important for the purpose of this study – to identify a safer method of contraception. These data can help a nursing practice provide the patient with a total amount of information, familiarize him with the risks and monitor his condition and indicators associated with the harmful effects of contraception.
Article “Systematic review and meta-analysis of the association of combined oral contraceptives” deeply explores and reveals the relationship between the influence of specific female hormones on the development of blood clots. Even when using hormonal COCs, undesirable effects can be reduced by paying attention to the dosage of hormones and knowing the mechanisms of their action. For research, this is important not only from a practical medical point of view but as confirmation of the thesis about higher risks associated with hormonal contraception than with non-hormonal.
Method of the Studies
Both studies are reviews of other studies on the topic but have different selection criteria. In their research, Teal & Edelman included randomized clinical trials, other systematic reviews, and guidelines (Teal & Edelman, 2021). Oedingen et al. (2018) only original studies with a case-control or cohort design were used in the paper. Thus, the second article is based on more reliable primary sources. Meta-analysis and system review benefit is in a large amount of processed data that was collected in different places and over a long period of time. Therefore, there is no question of the reproducibility of the results, as many similar studies are being reviewed. The disadvantages and limitations of this method include the creation of an inaccurate sample, errors and coarsening in the data analysis, the researcher’s bias, and the lack of detail.
Results of the Studies
Key research findings have shown that there is indeed a strong relationship between progesterone and estrogen-containing contraceptives and an increased risk of thrombosis in healthy women. Oedingen et al. (2018, p.68) concluded that “the COC with the lowest possible dose of estrogen, levonorgestrel, and ethinylestradiol should be prescribed” to minimize adverse effects associated with blood clots appearance. The Teal & Edelman (2021, p. 2507) study supports these findings, indicating that estrogen-containing contraceptives “raise the risk of venous thrombosis from 2 to 10 venous thrombosis per 10000 woman-years to 7 to 10”. Moreover, copper-containing IUDs are a more effective method of contraception than COCs, providing pregnancy rates are 1% per year (Teal & Edelman, 2021). This confirms the original assumption of a higher risk of thrombosis in women who take COCs than those who use IUDs.
Ethical Considerations
A meta-analysis is a type of study that is considered free from ethical issues related to patient interests. The review is carried out at a high level of abstraction and uses other studies in which patients’ consent to the processing of personal data has already been obtained. However, such scientific work has significant ethical issues with the research attitude. First, researchers must evaluate their sample bias, availability bias, citation bias, etc. Secondly, the authors of such studies can select data that confirm their position that has already been formed without having sufficient data for this.
In both of these articles, the authors address research limitations and point out insufficient data in some cases. For example, Teal & Edelman (2021, p. 2516) admin that the “quality of summarised evidence was not evaluated,” and some COC benefits were not covered. The authors of the articles drew attention to the detailed description of the sampling criteria for the study. Oedingen et al. (2018) give a detailed list of sample exclusion criteria, including any comorbidities and drugs that may interfere with the analysis. The authors facilitate the work of other researchers by indicating the selection methodology. Additionally, they independently designate parts of the work that require rechecking or additional research.
Conclusion
In this paper, we evaluated two articles investigating the effect of oral contraceptives and IUDs on developing thrombosis in women of reproductive age. The women’s age category in the selected articles was broader than in the study but still representative, as healthy women 21-49 years old were selected for analysis. Selected papers support the claim that non-hormonal contraceptives have a significantly lower risk of developing blood clots. Hormone-containing COCs do have a chance of developing thrombosis in young and adult women. Nevertheless, it must be considered that both studies are systematic reviews and meta-analyses, which entails possible limitations.
References
Kavanaugh, M. L., & Jerman, J. (2018). Contraceptive method use in the United States: Trends and characteristics between 2008, 2012 and 2014.Contraception, 97(1), 14-21. Web.
Oedingen, C., Scholz, S., & Razum, O. (2018). Systematic review and meta-analysis of the association of combined oral contraceptives on the risk of venous thromboembolism: The role of the progestogen type and estrogen dose.Thrombosis Research, 165, 68-78. Web.
Teal, S., & Edelman, A. (2021). Contraception selection, effectiveness, and adverse effects: A review.JAMA, 326(24), 2507-2518. Web.