Risk of venous thromboembolism in women with polycystic ovary syndrome: a population-based matched cohort analysis

Article Figures & Tables

Table 1:

Health care and combined oral contraceptive use at baseline

Characteristic	Polycystic ovary syndrome^*	Matched controls
Women, no.	43 506	43 506
Age, yr, mean	28.7	28.9
Health care use, % of women
Admission to hospital	3.57	4.05
Emergency department visit	4.79	4.45
Physician office visit	51.31	50.08
Combined oral contraceptive use
New user,^† no. (%) of women	20 150 (46.32)	20 278 (46.61)
Prevalent user,^‡ no. (%) of women	23 356 (53.68)	23 228 (53.39)
Prior time on combined oral contraceptives, mean, d	103	103
Total time on combined oral contraceptives, mean, d	201	202
Number of combined oral contraceptives products used in the past, mean	0.6	0.6
Combined oral contraceptive, % of women
Desogestrel, μg ethinyl estradiol
20	3.45	3.38
25	0.47	0.46
30	8.39	8.31
Drospirenone, μg ethinyl estradiol
20	7.46	8.45
30	20.81	21.02
Levonorgestrel, μg ethinyl estradiol
20	5.19	5.14
30	3.75	3.72
Triphasic	2.35	2.11
Norethindrone, μg ethinyl estradiol
35	10.53	10.28
Norethindrone acetate, μg ethinyl estradiol
20	4.60	4.48
30	2.74	2.66
35	1.51	1.55
Norgestimate, ethinyl-estradiol μg
25	5.78	5.68
35	18.31	18.21
Norgestrel, μg ethinyl estradiol
30	4.66	4.55

↵* Defined as a claim for polycystic ovary syndrome (International Classification of Disease, 9th Revision [Clinical Modification (ICD-9-CM)] 256.4).
↵† Initiated combined oral contraceptive therapy after the polycystic ovary syndrome claim.
↵‡ Evidence of combined oral contraceptive use during the 365-day period before the polycystic ovary syndrome claim.

Table 2:

Comparison of medication use and comorbidities at cohort entry and study end

Variable	Cohort entry		Study end

	PCOS^*	Matched controls	PCOS^*	Matched controls
Medication use, % of women

ACE inhibitor or ARB	2.18	2.57	5.06	5.10

Beta blocker	3.42	3.52	7.95	6.80

Benzodiazepine	8.93	8.06	20.77	16.95

Calcium-channel blocker	0.92	1.06	2.51	2.18

Diabetes medications	20.31	20.65	42.88	21.55

SSRI or tricyclic antidepressant	17.09	17.32	31.76	28.88

Statin or fibrate	2.45	2.79	5.79	5.23

Comorbidities, % of women

Acne	11.04	10.92	24.15	19.65

Asthma	6.93	6.92	15.32	12.82

COPD	3.34	3.45	11.45	9.29

Diabetes	6.70	8.31	14.87	12.23

Dysmenorrhea	5.79	5.71	14.23	10.95

Endometriosis	2.71	2.82	7.42	4.88

Hyperlipidemia	10.47	10.91	27.10	20.15

Hypertension	7.82	8.40	18.70	14.75

Hypothyroid	8.23	8.32	17.23	12.67

Ovarian inflammation	1.74	1.83	5.72	3.84

Vaginal inflammation	12.56	12.52	31.22	27.64

Uterine leiomyoma	2.05	2.03	5.96	4.65

Irregular menstrual cycle	40.04	40.06	72.07	54.15

Migraine	5.53	5.67	15.10	12.33

Mood or anxiety disorder	15.96	16.26	34.09	29.65

Obesity	13.35	13.32	33.11	21.04

Peptic ulcer disease	0.40	0.42	1.32	1.03

Premenstrual tension syndrome (PMS or PMDD)	1.42	1.34	4.12	2.97

Sleep disorder	0.82	0.88	3.26	1.98

Smoking	2.57	2.71	7.31	6.85

Note: ACE = angiotensin-converting enzyme, ARB = angiotensin-receptor blocker, COPD = chronic obstructive pulmonary disorder, PCOS = polycystic ovary syndrome, PMDD = premenstrual dysphoric disorder, PMS = premenstrual syndrome, SSRI = selective serotonin reuptake inhibitor.
↵* Defined as a claim for PCOS (International Classification of Disease, 9th Revision [Clinical Modification (ICD-9-CM)] 256.4).

Table 3:

Risk of venous thromboembolism associated with PCOS in women taking the combined oral contraceptive pill

Variable	Cox proportional hazards models	Relative risk regression
PCOS claim	2.14 (1.41–3.24)	2.12 (1.40–3.21)
Composite PCOS definition^*	2.24 (1.62–3.10)	2.23 (1.61–3.08)
PCOS symptoms and treatment
Anovulation	1.72 (0.75–3.98)	1.70 (0.75–3.89)
Hirsutism	2.49 (1.35–4.59)	2.43 (1.30–4.56)
Spironolactone	1.89 (1.15–3.10)	1.86 (1.14–3.03)

Note: PCOS = polycystic ovary syndrome.
↵* Claims for PCOS, anovulation, hirsutism, spironolactone treatment, or PCOS-related procedures.