What percentage of women on oral contraceptives (OCs) develops gallstones or cholecystitis? Also, if OCs are a risk for blood clots, why are they commonly prescribed to those who smoke? — Amy Valle, PA-C, Downingtown, Pa.

It was long thought that oral contraceptives increased a woman’s risk of gallstones 2.0 to 2.5 times over those not taking OCs. Data from the Heart and Oestrogen/Progestin Replacement Study and the Women’s Health Initiative postmenopausal hormone trial concluded that there is no significant increase premenopausally, but postmenopausal women on estrogen-based hormone replacement therapy do have a significant increase in gallstones (Expert Opin Drug Saf. 2006;5:117-129).

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Estrogen is definitely linked to an increased risk of thromboembolic disease, and this risk is especially high in women who also smoke. Progestin-only contraceptives should be recommended. The increased risk is greatest in women older than age 35 years, who have a much higher risk of developing clots. Each patient must weigh the risks and benefits of using OCs. The clinician’s role is to educate about risk and offer alternative contraceptive methods when possible. For further discussion of thromboembolic risk in women, see Semin Thromb Hemost. 2006;32:709-715. For a discussion of contraceptive choice for women in specific populations, see Semin Reprod Med. 2010;28:147-155. — Claire Babcock O’Connell, MPH, PA-C (151-2)

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