Introduction:
Venous thromboembolism (VTE), is a rare complication seen in women
receiving combined oral contraception (COC) containing estrogen and
progesterone. The thrombotic risk of COCs is associated with hemostatic
alterations, most commonly protein C resistance (1). Adolescent females
have the lowest absolute risk for VTE while receiving COCs when compared
to older age groups with an absolute risk for VTE to be less than 1 per
1000 exposure years (1-5). Large population case-control studies report
an incidence of VTE in women age category 15-19 years to be 4.2 events
per 10,000 exposure years versus 0.7 events per 10,000 years in COC
non-users (5).
Despite the small but real increased risk for VTE in female COC users,
other thrombosis risk factors such as obesity, further increase VTE risk
during COC use (1-5; 11-27). We present a case series of five adolescent
females with obesity (BMI ≥ 30 kg/m2), who developed
VTE complications in the setting of COC use. This observation raises the
concern of increased thrombosis risk in obese adolescents with COC use
and underscores the need to explore safer hormonal alternatives in this
patient population.