Hormonal contraceptives increase the risk of cryptogenic stroke in women

New Delhi: Hormonal contraceptives are a part of women's lives as they are a convenient and effective option for preventing pregnancy and managing menstrual cycle. However, new findings reveal that combined oral hormonal contraceptives (which contains both oestrogen and progestogen) may significantly increase the chance of women experiencing a cryptogenic stroke. This is a sudden and serious type of stroke that occurs with no obvious cause.

The findings were presented at the European Stroke Organisation Conference. The researchers said that, surprisingly, in younger adults, especially women, cryptogenic strokes make up approximately 40 per cent of all strokes.

The study also suggests that there may be sex-specific factors which contribute to this risk, such as hormonal contraception use. 

At this year’s conference, researchers presented findings from the Secreto study. This was an international investigation that has been conducted into the causes of unexplained strokes in young people aged 18 to 49. The study enrolled 608 patients with cryptogenic ischaemic stroke from 13 different European countries.

One of the highlights of the study was that women who used combined oral contraceptives were three times more likely to experience a cryptogenic stroke compared to non-users. These results stood, even after researchers adjusted for other factors which may have contributed to stroke risk (such as obesity and history of migraines).

A study published earlier this year, wherein, researchers tracked over two million women, found that combined hormonal contraceptives which, including the pill, intrauterine devices (IUD), patches and vaginal rings, which all contain both synthetic oestrogen and progestogen, were linked to higher risks of both stroke and heart attack.

However, they also looked at a progestin-only contraceptive (the IUD) and found there was no increased risk for either heart attacks or strokes.

Both of these recent findings suggest oestrogen may be the main driver of stroke risk. While absolute risk is still low, meaning fewer than 40 in every 100,000 women using a combined hormonal contraceptive will experience a stroke, the population-level impact is significant considering the number of women worldwide that use a combined hormonal contraceptive.

Despite the risks associated with combined hormonal contraceptives, many women continue to use them – either because they aren’t fully informed of the risks or because the alternatives are either less effective, less accessible or come with their own burdens.

Part of the reason this trade-off has become so normalised is the persistent under-funding and under-prioritisation of women’s health research. Historically, medical research has focused disproportionately on men – with women either excluded from studies or treated as an afterthought.

This has led to a limited understanding of how hormonal contraceptives affect female physiology beyond fertility control. As a result, the side-effects remain poorly understood, under-communicated and under-addressed.

(With PTI inputs)

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