BMJ
Hormonal contraception linked to increased risk of stroke, MI
Study details: This real-world, nationwide, prospective cohort study included 2,025,691 women aged 15 to 49 years in Denmark, tracked from 1996 to 2021. Participants had no prior history of arterial or venous thrombosis, antipsychotic use, cancer, thrombophilia, liver or kidney disease, polycystic ovary syndrome, endometriosis, infertility treatment, hormone therapy use, oophorectomy, or hysterectomy.
Results: Over 22,209,697 person-years of follow-up, 4,730 ischemic strokes and 2,072 MIs were recorded. Combined oral contraceptives were associated with a twofold increased risk of both ischemic stroke and MI compared with non-users. Progestin-only pills and other hormonal methods also showed elevated risks, except for the levonorgestrel-releasing IUD, which didn’t significantly increase the risk.
Clinical impact: These findings highlight the need for careful consideration when prescribing hormonal contraceptives, particularly for women with other risk factors for arterial thrombotic events. Although absolute risks were low, clinicians should nonetheless discuss these risks with patients and consider alternative contraceptive methods where appropriate.
Source:
Yonis H, et al. (2025, February 14). BMJ. Stroke and myocardial infarction with contemporary hormonal contraception: real-world, nationwide, prospective cohort study. https://pubmed.ncbi.nlm.nih.gov/39938934/