Researchers analyzed the prescription records of over two million Danish women aged 15 to 49 between 1996 and 2021. They found that combined estrogen-progestin contraceptives were associated with a doubling of the risk of ischemic stroke and heart attack.
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Progestin-only contraceptives, including pills and implants, showed a slightly increased risk, but lower than that of combined pills. Non-oral methods, such as the vaginal ring and patch, had higher associated risks, with a significant increase in the risks of stroke and heart attack.
The progestin-only intrauterine system was the only hormonal contraceptive not linked to an increased risk, making it a safer option for cardiovascular health. The duration of use did not seem to influence the risk.
This observational study does not allow for definitive conclusions on causality, but the results are robust due to the use of high-quality registry data. Researchers advise clinicians to consider these risks when prescribing hormonal contraceptives.
Cardiovascular diseases are rare in young women, but the side effects are serious. With approximately 248 million women using hormonal contraceptives daily, these findings have significant public health implications.
Researchers call for educational campaigns to help women make informed choices and for training healthcare providers in evidence-based counseling. Policymakers should also prioritize the accessibility of safer alternatives, especially in low-resource settings.
The study was funded by Health Insurance 'Denmark' and published in
The BMJ. Researchers emphasize that although the absolute risks are low, they must be considered in the benefit-risk assessment when prescribing hormonal contraceptives.
What is an ischemic stroke?
An ischemic stroke occurs when a blood clot blocks an artery that supplies blood to the brain. This deprives brain cells of oxygen and nutrients, causing them to die within minutes.
Symptoms include sudden weakness or numbness of the face, arm, or leg, especially on one side of the body. Other signs may include confusion, speech difficulties, vision problems, and trouble walking.
Risk factors include high blood pressure, smoking, diabetes, obesity, and the use of certain hormonal contraceptives. Prompt treatment is crucial to minimize brain damage.
Prevention involves a healthy lifestyle, management of underlying medical conditions, and in some cases, the use of medications to prevent blood clots.
How do hormonal contraceptives work?
Hormonal contraceptives work by releasing synthetic hormones that mimic the body's natural estrogen and progesterone. These hormones prevent ovulation, thicken cervical mucus, and alter the uterine lining to prevent fertilization.
Combined methods contain both estrogen and progestin, while progestin-only methods contain only progestin. Administration methods vary, including pills, patches, vaginal rings, implants, and injections.
Each method has its advantages and disadvantages, depending on individual preferences, medical history, and risk factors. It is important to consult a healthcare professional to choose the most suitable method.
Hormonal contraceptives are highly effective in preventing unwanted pregnancies, but they can have side effects, including an increased risk of cardiovascular problems in some women.