Oral Contraceptives Linked to Tripled Stroke Risk in Women
New Delhi: Research has revealed that women using combined oral contraceptives (COC), commonly known as the pill, face a threefold increased risk of experiencing an unexpected stroke compared to those who do not use such medications. These findings were presented at a conference hosted by the European Stroke Organisation in Helsinki on May 20.
The pill is a hormonal contraceptive containing both oestrogen and progestogen, designed to prevent the ovaries from releasing an egg each month. A study conducted by Istanbul University has established a connection between cryptogenic ischaemic stroke (CIS) and oral contraceptives. The research involved 268 women aged 18 to 49 who experienced unexpected strokes, compared with 268 women in the same age group without a history of stroke.
Studies from 2019 and 2022 have echoed these concerns, highlighting the need for immediate attention to the direct vascular effects of COCs. Healthcare professionals acknowledge that prolonged use and elevated oestrogen levels contribute to stroke risks.
Key Findings and Expert Insights
- Dr Anuradha Kapur, principal director of obstetrics and gynaecology at Max Smart Super Specialty Hospital, noted that while medications can increase the likelihood of ischaemic strokes, they typically require existing risk factors to cause harm. She explained, ‘Think of it as adding gasoline to a fire that has not yet been lit. If you have a genetic factor or already have a risk factor, the pill can be the trigger.’
- Dr Mine Sezgin, lead author of the study from Istanbul University, emphasized that the association between oral contraceptives and stroke risk remains strong even when accounting for other known risk factors. She suggested that additional mechanisms, possibly genetic or biological, may be at play.
- Dr Renu Gupta, director of obstetrics and gynaecology at Sri Balaji Action Medical Institute, highlighted that COC use could exacerbate complications in women with underlying health conditions, including undiagnosed thrombophilias or autoimmune conditions.
While further prospective studies are needed, clinicians are advised to exercise caution when prescribing the pill to women with known vascular risk factors or a history of ischaemic stroke.
Factors Influencing Stroke Risk
- Prof Manjari Tripathi, head of the neurology department at AIIMS, noted that COC usage consistently correlates with increased ischaemic stroke risk, particularly in women with pre-existing health risk factors.
- COC usage increases ischaemic stroke risk by 1.6 to 2 times, with higher risks in women experiencing migraines with aura. The risk intensifies for women who smoke, have high blood pressure, migraines with aura, or a stroke history.
- The oestrogen component may increase blood coagulability and clot formation. Dr Vinit Suri, senior consultant of neurology at Indraprastha Apollo Hospitals, noted that first-year usage presents the highest risk, affected by oestrogen dosage. Modern pills contain lower oestrogen levels, reducing risks compared to older formulations. Risk increases with smoking, hypertension or age above 35. Healthy young women face minimal absolute risk, with pregnancy presenting higher stroke risks than oral contraceptives.
Dr Bhaskar Shukla, consultant neurologist at PSRI Hospital, noted that the real risk lies in stacking oestrogen on top of other vascular triggers—smoking, uncontrolled hypertension or migraine with aura—where non-oestrogen methods are clearly the wiser bet. Informed choice, annual check-ups and the growing menu of highly effective LARC devices mean women no longer have to trade peace of mind for modern contraception, he added.
Conclusion
The study underscores the importance of careful consideration when choosing contraceptive methods, particularly for women with existing health risks. While the pill remains a popular option, its potential to increase stroke risk highlights the need for personalized medical advice and regular health monitoring.