Summary:  Oral Contraceptive Use Increases Risk of Stroke

  • Both Estrogen and Progesterone based Oral Contraceptive use increase stroke risk.


    It is widely accepted that oral contraceptive use increases the risk of developing stroke. Most oral contraceptive today are a combination of estrogen and progesterone.  In the various studies reviewed there was no uniform combination of oral contraceptive used in each study to draw direct comparisons thus the results are difficult to interpret.


    The risk of developing a stroke increases with oral contraceptive containing increasing amounts of estrogen.  The manner in which these strokes occur is poorly understood. Progesterones are categorized by generation, first, second, and third. Third generation progesterones are the most recent in development and considered to be improvements over earlier generations.  There is evidence to suggest that women taking  oral contraceptive containing 3rd generation progesterone are at a 2-fold greater risk of developing venous thromboembolism and subsequent stroke than women taking oral contraceptive containing earlier generation progesterones.  


    Oral contraceptive have also be shown to cause increases in blood pressure which could lead to strokes in women with other risk factors that increase the chance of strokes.  With the introduction of oral contraceptives with lower doses of estrogen the reports have been more conflicting.  Some reports found increased incidence of strokes while other reports with lower
    doses of estrogens have found no increase in strokes.  Studies of  oral contraceptive  with progesterone only ( which have been advocated for women with risk factors for stroke), have been small and conclusions should be regarded as tentative.

1Sarkis Morales-Vidal, MD., Michael J. Schneck, MD., and Jose Biller, MD. Clinical Summary: Oral Contraceptives and Stroke,, May 14, 2009.


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