Connection between birth control and strokes: Implications, risks, and additional insights
In the realm of birth control, it's essential to be well-informed about the potential risks associated with each method. A recent review suggests that combined hormonal contraceptives, particularly oral contraceptives containing estrogen and progestin, may carry a higher risk of ischemic stroke compared to non-users [1][3].
Combined hormonal contraceptives, such as oral contraceptive pills, patches, and certain forms of the birth control shot, increase the risk of ischemic stroke by approximately 60% [3]. This risk is particularly high in women who smoke, have high blood pressure, migraines (especially with aura), or other pre-existing conditions [1][2].
However, it's important to note that the methods with the lowest stroke risk include non-hormonal contraceptives (e.g., copper IUDs) and progestin-only methods such as progestin-only pills, implants, or injections. These methods avoid estrogen, which is largely responsible for the increased clotting and stroke risk seen with combined hormonal methods [1].
Several factors can increase the risk of stroke in users of hormonal birth control. These include the estrogen dose and type, smoking, age, pre-existing medical conditions, duration, and timing of use [1][2][4]. For instance, higher estrogen doses in combined oral contraceptives correlate with a greater stroke risk [4]. Smoking significantly raises the likelihood of serious cardiovascular side effects, including stroke, in combination hormonal contraceptive users [2][1].
Older reproductive-age women (especially over 35) and those with pre-existing conditions such as hypertension, migraines (especially with aura), obesity, and a history of blood clots also face an increased risk [1]. The highest risk occurs when first starting or restarting hormonal birth control after a break [2].
It's worth mentioning that some research found no increased stroke risk of patches or vaginal rings containing low dose ethinyl estradiol [1]. However, little data is available on the stroke risk of the transdermal patch and vaginal ring, which contain both progestin and estrogen, in the form of ethinyl estradiol [2].
In contrast, oral contraceptives containing doses of estrogen of 50 μg or above may link to a risk of ischemic stroke [3]. The total stroke risk may increase with each 10 μg of estrogen dosage [1].
In summary, combined hormonal contraceptives, particularly oral contraceptives containing estrogen and progestin, carry the highest stroke risk mainly due to estrogen’s effect on blood clotting, exacerbated by smoking and other factors. Progestin-only or non-hormonal methods have the lowest stroke risk and are safer alternatives for women with stroke risk factors [1][2][3][4].
Planned Parenthood states that the birth control shot can increase the risk of blood clots, which can lead to stroke or damage the heart and lungs [2]. It's crucial to discuss contraceptive options and risk factors with a healthcare provider to make an informed decision and lower the risk of stroke.
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