Hormonal contraception and stroke

Introduction
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By Sarkis Morales-Vidal MD, Michael J Schneck MD, Murray Flaster MD PhD, and Jose Biller MD

Since their introduction, hormonal contraceptives have been associated with an increased risk of stroke. With newer formulations, however, the magnitude of that risk has become less clear. In this clinical summary, Drs. Sarkis Morales-Vidal, Michael Schneck, Murray Flaster, and José Biller from the Department of Neurology at Loyola University of Chicago, Stritch School of Medicine, discuss data regarding risk of stroke associated with different types of oral contraceptives. The summary also includes an expanded explanation of the possible pathophysiology of hormonal contraceptive-related stroke. Special risk groups, including women who smoke, are migraineurs, or who have arterial hypertension are specifically considered as well. In addition, a brief discussion is included regarding stroke risks associated with the ovarian hyperstimulation syndrome and stroke risks among transsexuals.

Key Points

  • Oral contraceptives may increase the risk of ischemic stroke, but the absolute risk remains very small.
  • Oral contraceptives do not seem to increase the risk of hemorrhagic stroke in the general population.
  • Oral contraceptives should not be offered to women with migraine with aura.

In This Article

Introduction
Historical note and nomenclature
Clinical manifestations
Clinical vignette
Etiology
Pathogenesis and pathophysiology
Epidemiology
Prevention
Differential diagnosis
Diagnostic workup
Prognosis and complications
Management
References cited
Contributors