By Danielle Melvin, N.D.

Combined oral contraceptives (COCs) have been a cornerstone of birth control for decades, offering women effective options for pregnancy prevention, hormonal regulation, and symptom management related to conditions like acne and menstrual irregularities. However, one concern that has long accompanied the use of COCs is the potential risk of deep vein thrombosis (DVT)—a serious condition where blood clots form in deep veins, often in the legs, which can lead to life-threatening complications like pulmonary embolism.

Norethindrone vs. Drospirenone: How Do They Compare?

  • Norethindrone is a first-generation progestin with a long history of use. It is generally well-tolerated and has been associated with a lower risk of side effects, including thrombotic events.
  • Drospirenone, on the other hand, is a newer, fourth-generation progestin. It has gained popularity because of its anti-androgenic effects, making it beneficial for women with acne or hormonal imbalances. However, previous studies have suggested that drospirenone might carry a higher risk of DVT compared to earlier-generation progestins like norethindrone.

Study Findings: Who’s at Higher Risk?

  1. Higher DVT Risk with Drospirenone: The study confirmed that women who used drospirenone/ethinyl estradiol had a higher incidence of DVT compared to those using norethindrone/ethinyl estradiol. This aligns with previous research that has raised concerns about the thrombotic risks associated with drospirenone.
  2. Overall Risk Still Low: While the risk was higher with drospirenone, it’s important to emphasize that the overall risk of developing DVT for healthy women using COCs remains low. For most women, the benefits of contraception, such as preventing unintended pregnancies and managing menstrual symptoms, far outweigh the risks.
  3. Other Risk Factors Matter: The study also reinforced the idea that other individual risk factors—such as being overweight, smoking, or having a personal or family history of blood clots—play a significant role in determining DVT risk. Women with these risk factors should carefully discuss contraceptive options with their healthcare provider

Key Takeaways for Choosing a COC:

  • Know Your Risk Factors: Before starting any contraceptive, it’s crucial to assess your personal risk factors for DVT. If you have a family history of blood clots, are a smoker, or have other medical conditions that increase your risk, this should factor into your choice of contraception.
  • Discuss Options with Your Clinician: Healthcare providers can help guide you through the pros and cons of different contraceptives based on your health history. They can recommend the best option based on your individual risk profile.
  • Consider Non-Hormonal Alternatives: If you’re at high risk for DVT but still need effective birth control, non-hormonal options like the copper IUD or barrier methods may be worth considering. These options do not carry the same clotting risks as estrogen-containing contraceptives.
  • Weigh the Benefits and Risks: For many women, the benefits of using a drospirenone-based contraceptive, such as better control of acne or hormone-related mood swings, will far outweigh the slight increase in DVT risk. It’s all about finding the right balance for your health and lifestyle.

Conclusion

The choice between norethindrone and drospirenone largely depends on individual health factors and priorities. If you’re concerned about the risk of DVT, norethindrone offers a lower-risk option, while drospirenone may still be a good choice for women who prioritize benefits like acne relief and aren’t at elevated risk for blood clots. Always consult with your healthcare provider to make the best decision for your needs.  The clinicians at A Woman’s Time can  discuss best options for you and offer prescriptions.  Our Women’s Health Nurse Practitioner, Shoshana Farber is an expert in this topic.

Stalas, J., Morris, R., Bu, K., von Bargen, K., Largmann, R., Sanford, K., … & Cheng, F. (2024). Comparing the risk of deep vein thrombosis of two combined oral contraceptives: Norethindrone/ethinyl estradiol and drospirenone/ethinyl estradiol. Heliyon10(5).