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Oral contraceptives and stroke.

M G Bousser1, S J Kittner

  • 1Hôpital Lariboisière, Service de Neurologie, Paris, France. bousser@ccr.jussieu.fr

Cephalalgia : an International Journal of Headache
|September 21, 2000
PubMed
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Oral contraceptives with high estrogen content increase stroke risk, while low-dose options pose minimal risk. Combined with risk factors like hypertension, oral contraceptive use elevates stroke and cerebral venous thrombosis risks.

Area of Science:

  • Neurology
  • Epidemiology
  • Pharmacology

Background:

  • Over 25 studies since 1962 have investigated the link between oral contraceptives (OCs) and stroke.
  • Epidemiological studies, primarily case-control and cohort designs, are the main source of data.
  • These study designs have inherent limitations and potential biases.

Purpose of the Study:

  • To synthesize findings from epidemiological studies on oral contraceptive use and stroke risk.
  • To identify factors influencing the relationship between OCs and cerebrovascular events.
  • To assess the overall risk-benefit profile of low-dose oral contraceptives.

Main Methods:

  • Systematic review and synthesis of existing epidemiological research on OCs and stroke.
  • Analysis of stroke risk stratified by estrogen content and presence of co-existing risk factors.

Related Experiment Videos

  • Evaluation of data concerning cerebral venous thrombosis (CVT) associated with OC use.

    • Main Results:

    • High estrogen content (≥50 µg) in OCs is associated with increased risk of all stroke subtypes and stroke mortality.
    • Low estrogen content (<50 µg) OCs present a very low or negligible stroke risk.
    • OC use significantly elevates cerebral venous thrombosis risk, especially with congenital thrombophilia.
    • Associated risk factors like hypertension, smoking, and migraine substantially amplify stroke risk with OCs.

    Conclusions:

    • Low-dose oral contraceptives have a very low stroke risk, particularly when risk factors are controlled.
    • The benefits of low-dose OCs generally outweigh the risks for most users.
    • Further research is needed on progestogen-only contraceptives and their stroke risk profile.