Venöse Thromboembolien bei Jugendlichen mit Kontrazeptiva der vierten Generation

Zusammenfassung

Venöse Thromboembolien (VTE) sind eine seltene, aber gefürchtete unerwünschte Arzneimittelwirkung kombinierter oraler Kontrazeptiva. Moderne orale Kontrazeptiva enthalten neuartige Gestagene, welche unter Verdacht stehen, häufiger als altbekannte Gestagene thrombotische Ereignisse hervorzurufen. Drospirenon ist eines dieser neuartigen Gestagene der vierten Generation mit antiandrogener und antimineralcorticoider Wirkung. Gerade Mädchen und junge Frauen erhoffen sich neben der verhütenden Wirkung positive Effekte auf Hautbild und Körpergewicht. Die Sicherheit dieses Gestagens stand jedoch im letzten Jahrzehnt immer wieder zur Diskussion.

Um einen Überblick über die aktuelle Datenlage zum VTE-Risiko von Mädchen und jungen Frauen unter Drospirenon-haltigen Kontrazeptiva zu erhalten, wurde eine ausführliche Literaturrecherche durchgeführt. Es zeigt sich eine vergleich­bare Risikoerhöhung wie orale Kontrazeptiva der dritten Generation und der Antiandrogene. Im Vergleich zu Kontrazeptiva der zweiten Generation mit dem Gestagen Levonorgestrel besteht eine Risikoerhöhung um etwa das Doppelte (1,0- bis 2,8-fach) bei Frauen zwischen 10 und 55 Jahren. Genaue Daten zum Risiko in der Altersgruppe unter 18 Jahren fehlen weitgehend. Das Risiko für eine VTE ist bei jungen Frauen in den ersten Anwendungsmonaten zusätzlich erhöht. Bis sich die Datenlage für neuartige Gestagene verbessert hat und das Sicherheitsprofil klar definiert ist, sollte man bei jungen Frauen gut untersuchte orale Kontrazeptiva der zweiten Generation mit niedrigem ­Estrogengehalt und dem besseren Nutzen-Risiko-Verhältnis bevorzugen. In allen Fällen sollten die Patientinnen jedoch umfassend über Nutzen und Risiken der jeweiligen kontrazeptiven Methode aufgeklärt werden.

Abstract

Venous thromboembolism (VTE) is a rare, but feared adverse drug reaction of combined oral contraceptives. Modern oral contraceptives contain novel progestins, which are suspected of causing thrombotic events more frequently than well-known progestins. Drospirenone is one of those new fourth-generation progestins with antiandrogenic and antimineralocorticoid effects. Especially girls and young women do not only wish for contraception, but also for positive effects on skin and body weight. In the last decade, however, the safety of this progestin was often under discussion.

A detailed literature search was conducted to obtain an overview of currently available data on the risk of VTE among girls and young women using drospirenone-containing contraceptives. It appears that drospirenone-containing contraceptives have a similar increase in risk as third-generation oral contraceptives and antiandrogens. Compared to second-generation contraceptives containing the progestin levonorgestrel there is an approximate 2-fold risk increase (1.0 to 2.8-fold) in women aged 10–55 years. Accurate data regarding the risk in the age group under 18 years are lacking. Nevertheless, the risk of VTE appears to be higher in young ­women during the first months of treatment. Until more data for nov­el progestins are available and the safety profile is well defined well-studied second-generation oral contraceptives with low dose estrogen and better risk-benefit ratio should be preferred in young women. In any case, all patients should be comprehensively informed regarding the benefits and risks of each contraceptive method.

Schlüsselwörter

Jugendliche - Drospirenon - orale Kontrazeptiva - venöse Thromboembolien - Review

Key words

adolescents - drospirenone - oral contraceptives - venous thromboembolism - review

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