Hormonal birth control methods have been linked to stroke risk. While this concern exists, the overall risk for most individuals is generally low. This article provides information on the relationship between birth control and stroke, detailing mechanisms, specific contraceptive methods, and individual risk factors.
Understanding the Connection
Hormonal birth control influences stroke risk primarily through its effect on blood clotting. Estrogen, a hormone in many contraceptive methods, increases the production of clotting factors, making blood more prone to forming clots that can block blood vessels.
A stroke occurs when blood flow to a part of the brain is interrupted, often by a blood clot. If a clot blocks blood flow, it can lead to an ischemic stroke. Estrogen can also elevate blood pressure in some individuals, contributing to stroke risk. The risk of stroke while using estrogen-containing birth control is approximately 8 in 100,000 people.
Specific Hormonal Contraceptives and Risk
Different types of hormonal birth control carry varying levels of stroke risk. Combined oral contraceptives (COCs), which contain both estrogen and progestin, have been associated with an increased risk of ischemic stroke and heart attack compared to non-users, translating to about one extra stroke for every 4,760 women using the combined pill for one year.
Newer combined pills contain lower doses of estrogen (10-35 micrograms), reducing stroke risk compared to older, higher-dose versions. The vaginal ring and skin patch, which also contain both estrogen and progestin, have shown higher associated risks in some studies. The vaginal ring has been linked to a 2.4-fold increased risk of ischemic stroke, while the patch showed a 3.4-fold increase.
Progestin-only birth control methods, such as progestin-only pills (mini-pills), implants, and injections, generally have a lower or negligible increased risk of stroke compared to estrogen-containing methods. A progestin-only intrauterine device (IUD) is the only hormonal contraceptive method not linked to an increased risk of stroke or heart attack, making it a potentially safer option.
Individual Risk Factors
Several personal health factors can significantly increase an individual’s stroke risk when using birth control. Smoking is a major factor that amplifies the risk of blood clot formation and stroke, especially when combined with estrogen-containing contraceptives. High blood pressure, or hypertension, also contributes to an elevated stroke risk. It is important for blood pressure to be screened and managed before prescribing birth control.
Migraines with aura, characterized by visual disturbances or sensory changes, are another important risk factor. Women who experience migraines with aura have a higher risk of ischemic stroke if they use estrogen-containing birth control. A personal or family history of blood clots or clotting disorders also raises an individual’s susceptibility. Age, particularly being over 35, especially when combined with smoking, can further increase the risk.
Recognizing a Stroke
Recognizing stroke signs quickly is essential for immediate action and better outcomes. The F.A.S.T. acronym helps identify symptoms:
- F – Face drooping: Does one side of the face droop or feel numb? Ask the person to smile to check for unevenness.
- A – Arm weakness: Is one arm weak or numb? Ask the person to raise both arms to see if one drifts downward.
- S – Speech difficulty: Is speech slurred, or is the person unable to speak or hard to understand?
- T – Time to call emergency services: If any of these signs are present, even if they disappear, call 911 immediately.
Acting quickly can significantly improve the chance of recovery.
Mitigating Risk and Safe Prescribing
Minimizing stroke risk with birth control involves thorough medical consultation. Disclose a complete medical history to healthcare providers, including existing conditions, family history of blood clots or stroke, and lifestyle habits like smoking. Healthcare professionals will assess individual risk factors to determine the most suitable contraceptive method.
Regular check-ups monitor health changes affecting contraceptive choice. If risk factors are present, discuss alternative non-estrogen contraception methods, such as progestin-only or non-hormonal options. Lifestyle adjustments like maintaining a healthy weight, exercising regularly, and quitting smoking can also help lower overall stroke risk.