Hello, I had a question regarding oral contraception use in young women with essential thrombocytosis. They have an inherent thrombotic risk. We usually recommend IUD. If this is not possible, do you have any thoughts in regards to which (if any) OCP to use in this patient population. I was also wondering if you would advise medroxyprogesterone acetate (DMPA)? Thank you.

Caroline Cromwell, Assistant Professor Hematology
Mount Sinai School of Medicine

In general, combined oral contraceptives increase risk of thrombosis in susceptible women. Medroxyprogesterone acetate (DMPA) has also been shown to increase risk of thrombosis about 2-fold (so similarly). We usually recommend levonorgestrel releasing IUD or copper IUD for patients where we are concerned about thrombosis risk. The other alternative for an oral agent is the mini-pill, but some women don't tolerate side effects. If the patient chooses barrier methods, be sure she uses two things (e.g., condoms and spermicide).

Mary Cushman, MD, M.Sc.
Professor of Medicine, Hematology/Oncology Division
Department of Medicine
Professor of Pathology
University School of Vermont
Durham, NC