Loyola Stroke Specialists Find Birth Control Pills Increase Risk of Ischemic Stroke
March 14, 2018Categories: Neurology & Neurosurgery, Women's Health
Tags: Neurology Neurosurgery
MAYWOOD, IL – Oral contraceptives increase the risk of ischemic stroke, but this risk is very small among women who do not have other stroke risk factors, according to a comprehensive review in the journal MedLink Neurology by Loyola Medicine stroke specialists.
Birth control pills do not increase the risk of hemorrhagic strokes, wrote neurologists Sarkis Morales-Vidal, MD, and José Biller, MD. Ischemic strokes, which account for about 85% of all strokes, are caused by blood clots. Hemorrhagic strokes are caused by bleeding in the brain.
Several mechanisms have been proposed to explain why oral contraceptives increase stroke risk, including by raising blood pressure and by making blood hypercoagulable (more likely to clot).
When prescribing hormonal contraceptives, physicians should consider the type and dose of estrogen or progestin and route of administration (such as pill or patch). "The ideal drug is one with the lowest estrogen and progestin doses that will be effective in preventing pregnancy while minimizing adverse effects," Drs. Morales and Biller wrote.
For healthy young women without any stroke risk factors, the stroke risk associated with oral contraceptives is very small.
"However, in women with other stroke risk factors, the risk seems higher and, in most cases, oral contraceptive use should be discouraged," Drs. Morales and Biller wrote. These risk factors include high blood pressure, cigarette smoking and migraine headaches, especially migraines with sensory disturbances called aura (such as flashes of light and tingling in the hands or face).
However, women may not always be adequately screened. One previous study found that, among women with one or more stroke risk factors, only 15% recalled being advised not to start oral contraceptives and only 36% remembered being told to stop. 15% of women were still taking oral contraceptives despite being told to discontinue. These findings highlight the need to improve physician counseling and patient compliance, Drs. Morales and Biller wrote.
Their report is titled “Hormonal Contraception and Stroke.” It is an update of a report originally published in Medlink Neurology in 2003.
Dr. Morales is an associate professor and Dr. Biller is a professor and chair of the department of neurology of Loyola University Chicago Stritch School of Medicine.
About Loyola Medicine
Loyola Medicine, a member of Trinity Health, is a nationally ranked academic, quaternary care system based in Chicago's western suburbs. The three-hospital system includes Loyola University Medical Center (LUMC), Gottlieb Memorial Hospital, MacNeal Hospital, as well as convenient locations offering primary care, specialty care and immediate care services from nearly 2,000 physicians throughout Cook, Will and DuPage counties. LUMC is a 547-licensed-bed hospital in Maywood that includes the William G. and Mary A. Ryan Center for Heart & Vascular Medicine, the Cardinal Bernardin Cancer Center, the John L. Keeley, MD, Emergency Department, a Level 1 trauma center, Illinois's largest burn center, the Nancy W. Knowles Orthopaedic Institute, a certified comprehensive stroke center, transplant center and a children’s hospital. Having delivered compassionate care for over 50 years, Loyola also trains the next generation of caregivers through its academic affiliation with Loyola University Chicago’s Stritch School of Medicine and Marcella Niehoff School of Nursing.
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About Trinity Health
Trinity Health is one of the largest not-for-profit, faith-based health care systems in the nation. It is a family of 127,000 colleagues and more than 38,300 physicians and clinicians caring for diverse communities across 26 states. Nationally recognized for care and experience, the Trinity Health system includes 93 hospitals, 107 continuing care locations, the second largest PACE program in the country, 142 urgent care locations and many other health and well-being services. In fiscal year 2024, the Livonia, Michigan-based health system invested $1.3 billion in its communities in the form of charity care and other community benefit programs. For more information, visit us at www.trinity-health.org, or follow us on LinkedIn, Facebook, and X (formerly known as Twitter).