
The highest risk estimates were for estrogen-containing products
More than 250 million women across the world use hormone-based contraception—said to be a safe and reliable way to prevent pregnancy. However, according to a new study, they are also associated with a higher stroke and heart attack risk.
The research from Denmark published in The BMJ has drawn on prescription records to give more precise estimates for different products than previous studies. According to the scientists, the highest risk estimates were for estrogen-containing products, in particular the vaginal ring and skin patch.
The researchers stress that even though the absolute risk remains low, given the widespread use of these products and the seriousness of these conditions, clinicians should consider these potential risks when prescribing them.
Previously also, many studies suggested a potential increased risk of ischemic stroke and heart attack with their use, but findings have been inconsistent. There is also a lack of evidence on the effects of different hormone combinations—in which form they are taken—pills, implants, injections, vaginal rings, or skin patches—and for how long.
How was the study conducted?
For the study, researchers tracked national prescription records for more than two million Danish women aged 15-49 from 1996 to 2021 to find out if using contemporary hormonal contraceptives increased the risk of first-time stroke and heart attack compared with no use. They combined different types of contraception: estrogen-progestin pills, vaginal rings, patches, progestin-only pills, intrauterine devices, subcutaneous implants, and intramuscular injections.
All the women who had a history of blood clots, cancer, liver disease, kidney disease, polycystic ovary syndrome, endometriosis or infertility treatment, used psychiatric medication, hormone therapy, or had undergone a hysterectomy were excluded.
Results showed the most commonly used hormonal contraceptive—the combined estrogen-progestin pill—was associated with double the risk of ischemic stroke and heart attack, which means one extra stroke for every 4,760 women using the combined pill for a year and one extra heart attack for every 10,000 women per year of use.
What is an ischemic heart attack?
According to experts, ischemic heart disease refers to heart weakening caused by reduced blood flow to your heart. Typically, this reduced blood flow is the result of coronary artery disease, a condition that occurs when your coronary arteries narrow.
Ischemic heart disease is also known as cardiac ischemia or ischemic cardiomyopathy.
How do hormonal contraceptives work?
Hormonal contraceptives prevent pregnancy by stopping the release of eggs from the ovaries, thickening cervical mucus, and thinning the uterine lining. Also, these contraceptives thin the lining of the uterus, which reduces the likelihood of pregnancy.
Which are safer contraception methods?
According to experts, contraceptives that contain only progestin, like mini-pills, hormonal IUDs, and implants, are generally considered safer for heart health than combination pills. Non-hormonal options like copper IUDs and barrier methods pose no heart health risk.
However, being an observational study, it could not draw any definitive conclusions, and the researchers thought there could be other factors too that may be raising heart attack and stroke risk that they didn't consider. “Although absolute risks [of these incidents] were low,” the researchers wrote in the BMJ, “clinicians should include the potential risk... in their assessment of the benefits and risks when prescribing hormonal contraceptive methods.”
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