Women using pill risk death

By ALISON HORWOOD

New Zealand has the highest rate of women on the pill - and it is killing two of them every year.

Research released yesterday by the Ministry of Health has found that 20 women taking oral contraceptives have died of pulmonary embolism (a blood clot in the lungs) in the past 10 years.

The average age was 29 and none of the women had a history of clots.

The research shows that women on the pill are 10 times more likely to develop lung clots.

For every 10,000 women taking oral contraceptives, one a year will die.

The risk is twice as high for women taking third-generation pills than for those on second-generation contraceptives.

The study, by the professor of preventive and social medicine at Otago University, David Skegg, and colleagues, was also published yesterday in the London medical journal the Lancet.

An editorial in the same journal by Professor Neil Poulter of the Imperial School of Medicine in London said: "It is surprising that third-generation oral contraceptives are used extensively in New Zealand, since the regulatory authorities there have been conservative in their acceptance of other pharmacological agents ..."

But the Ministry of Health says it has no plans to withdraw third-generation pills - such as Femodene, Marvelon, Melodene, Mercilon and Minulet - from the shelves.

Ministry of Health Medsafe spokesman Dr Stewart Jessamine said: "The pill is relatively safe and effective, not just for preventing pregnancy but it has other benefits. There is insufficient evidence to warrant removing third-generation oral contraceptives from the market."

He said the new research was important but should be looked at in relation to other international studies which showed death from clots was rare among oral contraceptive pill-users.

The clots occur in the veins of the legs, normally causing swelling, tenderness and pain.

They may cause death when pieces of the clot dislodge and travel to the lungs.

Since 1996, the ministry has recommended that all doctors discuss the risks and benefits of each pill and let women make an informed decision.

"We believe the best approach is informed consent," said Dr Jessamine. "The doctor explains all the risks to the woman and she decides whether she wants to use second or third-generation pills."

However, he said, the ministry would advise doctors to consider recommending second-generation pills if possible.

The ministry will send a reminder letter to general practitioners and place advertisements in newspapers, and had set up an information line, 0800 930-039, so that people were informed.

Third-generation pills came onto the market in the 1980s and were promoted as a new drug causing fewer side-effects such as weight-gain and skin problems.

Although they became the pill of choice in New Zealand they are not widely used in Australia or the United States because of different drug company tariffs.

Since adverse publicity, the number of New Zealand women taking third-generation pills has fallen 50 per cent since 1996.

However, we still swallow more oral contraception per capita than any other country.

Professor Skegg said it was important to remember that death from blood clots "was a rare complaint" and the pill effectively prevented pregnancy and had other benefits, such as controlling acne.

He said women were high-risk if they were over 35 years of age, smoked, or had cardio-vascular problems.

THE PILLS

Progestogen

Brands: Femulen, Microlut, Microval, Noriday

Second generation

Progestogens

Brands: Brevinor, Levien, Loette, Microgynon 20ED/30, Monofeme, Nordette, Norimin, Synphasic, Trifeme, Triphasil, Triquilar

Anti-androgen

Brands: Diane-35

Third generation

Progestogens

Brands: Femodene, Marvelon, Melodene, Mercilon, Minulet

Combined high-dose oestrogen and progestogen

Brands: Biphasil, Microgynon 50, Nordiol, Norinyl-1, Ovral