This Journal recently published a review of the thrombogenic risk associated with drospirenone (DRSP)-containing combined oral contraceptives (COCs).1 The same issue has recently been addressed by the Food and Drug Administration (FDA). Like other studies the FDA study reported that the use of DRSP-containing COCs was associated with an increased risk of venous thromboembolism (VTE) as compared to levonorgestrel (LNG)-containing COCs [incidence rate ratio: all users 1.49 (95% CI 1.19–1.8), new users 1.48 (95% CI 1.07–2.05)].2

While epidemiological studies find it difficult to show causality they provide useful information on which to base clinical practice. Clinical decision-making has to be ethical. Beauchamp and Childress3 set out the most commonly applied framework in Western bioethics. …