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.