Oral contraceptives and stroke

Introduction
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By Sarkis Morales-Vidal MD and Michael J Schneck MD

Since their introduction, oral 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 article, Drs. Sarkis Morales-Vidal, Michael Schneck, Murray Flaster, and José Biller from the Department of Neurology at Loyola University Chicago, Stritch School of Medicine, discuss data regarding risk of stroke associated with different types of oral contraceptives. The article also includes an expanded explanation of the possible pathophysiology of oral 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 the stroke risks among transsexuals.

Key Points

  • Oral contraceptives may increase the risk of ischemic stroke, but overall the absolute risk remains very small.
  • Overall, 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.