Venous thromboembolic disease associated with hormonal contraceptives. Venous Thromboembolism Group of the Spanish Society of Internal Medicine and the Catalan Society of Contraception.

Combined hormonal contraceptives (CHCs) constitute one of the most widely used contraceptive methods in women of reproductive age and play a relevant role not only in contraception but also in the treatment of various gynecological conditions. However, their use is associated with an increased risk of venous thromboembolic disease (VTE; deep vein thrombosis and pulmonary embolism) due to the induction of a hypercoagulable state. This effect is primarily related to the estrogenic component and is modulated by the type of associated progestogen. The formulations containing low-dose estrogen and levonorgestrel, as well as progestin-only contraceptives (except medroxyprogesterone), have the most favorable prothrombotic profile and should be prioritized when hormonal contraception is indicated, particularly in women with additional risk factors. In women with VTE risk factors, the use of progestogen-only is recommended, as these are not associated with an increased thrombotic risk. The use of CHC after an episode of VTE requires individualized assessment; in selected cases, it may be temporarily continued during anticoagulant therapy. Before discontinuation of anticoagulation, CHCs should be replaced by a progestogen-only. CHCs are contraindicated in women with a history of VTE who are not receiving anticoagulant treatment. Appropriate selection of the contraceptive method and patient education regarding the symptoms of VTE are essential to minimize thrombotic risk, optimize safety, and promote early detection of thrombosis. This document provides an updated review of the thrombotic risk associated with different CHCs and offers practical recommendations for their management in women at high risk or with a history of VTE, emphasizing the need for individualized evaluation and a multidisciplinary approach.