Optimal management of hormonal contraceptives after an episode of venous thromboembolism

Optimal management of hormonal contraception in patients with venous thromboembolism (VE) requires an individualized approach considering its potential benefits and complications during and after anticoagulant treatment. Potential benefits include prevention of pregnancy and mitigation of menstrual bleeding that is often worsened after start of anticoagulation therapy. Current evidence suggests that patients may opt for a continuation of (all forms of) hormonal contraception during anticoagulant treatment, provided that they are adequately informed by the treating physicians. Combined oral contraceptives should be stopped before anticoagulant therapy may he discontinued, preferably after the second last menstrual cycle of the intended anticoagulant treatment period. If hormonal contraceptive treatment needs to he initiated in patients with a history of VTF., oral prostagen-only therapy or intra-uterine devices are to he preferred: this may he independent of the anticoagulation status and in light of a negligible risk of (recurrent) VTE. associated with their use.