Oral contraceptives and stroke: Foes or friends

Area of Science:

• Neurology
• Endocrinology
• Vascular Medicine

Background:

• Stroke incidence is higher in young women than young men, with oral contraceptive (OC) use implicated as a contributing factor.
• OCs, containing estrogen and progestogen, influence key physiological processes including blood clotting, lipid metabolism, endothelial function, and neurosteroid synthesis.
• Brain-derived 17β-estradiol, crucial for neuroprotection and cognitive functions, is affected by long-term OC exposure.

Approach:

• This review synthesizes existing literature on the relationship between OC use and stroke in young women.
• It elucidates the potential biological mechanisms underlying this association.
• The review identifies knowledge gaps to guide future research directions.

Key Points:

• OCs can alter hemostasis, lipid profiles, and vascular health, potentially increasing stroke risk.
• The impact of OCs on neurosteroid synthesis, particularly 17β-estradiol, may affect neuroprotection and neurological function.
• Comorbidities such as PCOS, sickle cell anemia, COVID-19, endocrine disruptors, and smoking can exacerbate the deleterious effects of OCs.

Conclusions:

• Further research is needed to fully understand the complex interplay between OC use, physiological changes, and stroke risk.
• Identifying specific OC formulations and individual susceptibility factors is crucial for risk stratification.
• Developing targeted preventive and therapeutic strategies for stroke in OC users is a critical goal.