- New research suggests combined oral contraceptive use is associated with a threefold increase in cryptogenic ischemic stroke (CIS).
- The study builds on evidence linking hormonal contraceptive use to cardiovascular events.
- The vaginal ring and skin patch have been associated with the highest risk of stroke and hear attack, but the absolute risk remains low.
- Smoking and certain health conditions can put females at a higher risk of cardiovascular issues linked to hormonal contraceptives.
- Discussing the pros and cons of hormonal birth control with your doctor can help inform your decision about which contraceptive method is best for you.
New research has revealed an increased risk of a cardiovascular event associated with hormonal contraceptive use.
The findings, presented on May 20 at the
CIS has no identifiable cause and accounts for up to 40% of ischaemic strokes that occur in young people.
The Searching for Explanations for Cryptogenic Stroke in the Young (SECRETO) study involved 268 females ages 18 to 49 with CIS and 268 stroke-free individuals in the same age range across 14 centers in Europe.
Of the study participants, 66 people with CIS and 38 controls were taking combined OCs. After adjusting for stroke risk factors like age, comorbidities (i.e., hypertension), smoking, migraine with aura, and obesity, researchers found that OC use was associated with a threefold increase in CIS.
“Our findings confirm earlier evidence linking oral contraceptives to stroke risk,” lead study author Mine Sezgin, MD, of the Department of Neurology at Istanbul University, said in a news release. “What’s particularly notable is that the association remains strong even when accounting for other known risk factors, which suggests there may be additional mechanisms involved — possibly genetic or biological,” she continued.
“We calculated the equivalent estrogen dose for each patient to ensure consistency,” Sezgin explained. “While our data provides important initial insights, larger studies are needed to determine if certain formulations carry different levels of risk. This knowledge could help guide more personalised contraceptive choices for women.”
While the researchers note that further investigation into this association is needed, they say the preliminary findings could help guide women to more personalized contraceptive choices. They also recommend that physicians exercise caution when prescribing combined OCs to women with known cardiovascular risk factors or a history of ischaemic stroke.
The findings build on evidence suggesting that certain types of hormonal contraceptives are associated with a higher risk of cardiovascular events.
A February 2025 study published in
However, the group of Danish researchers emphasized that the absolute risk was still low. They too recommended that physicians consider the risks of hormonal birth control to make informed, personalized decisions for patients.
Hormonal contraception is available in combined forms, including both estrogen and progestin, such as:
There are also progestin-only forms such as “mini” pills, injections, implants, and hormonal IUDs.
While previous studies have shown hormonal birth control could raise heart attack and stroke risk, not much was known about the risks associated with these individual formulations.
To answer this question, a team of researchers examined prescription records for over 2 million Danish females ages 15 to 49. Their goal was to determine whether subjects had a greater risk for heart attack or ischemic stroke (caused by blockages in the brain’s blood supply) compared to females who did not use hormonal contraceptives.
Various types of hormonal contraception in both combined and progestin-only forms were examined.
Exclusion criteria for the study included medical conditions such as:
- blood clots
- cancer
- liver disease
- kidney disease
- polycystic ovary syndrome (PCOS)
- endometriosis
- infertility treatment
- psychiatric medication use
- hormone therapy
- hysterectomy or oophorectomy
The researchers looked for cases of either heart attack or ischemic stroke among eligible female participants. Age, education, and pre-existing conditions like hypertension and diabetes were further factored in.
They found that combined estrogen-progestin birth control pills were linked to twice the risk of stroke and heart attack.
This would mean that, out of every 4,760 females, there would be one additional stroke if females used the pill for one year. Additionally, there would be one more heart attack for every 10,000 females after one year.
Among progestin-only contraceptives, the risk was somewhat higher but lower than that for the combined pills.
The vaginal ring and patch had higher risks, with the vaginal ring being linked to a 2.4 times greater risk for stroke and a 3.8 times greater risk for heart attack.
The patch was associated with a 3.4 times greater risk for stroke.
However, it was found that the progestin-only IUD was not linked to increased risk.
It should be noted that this was an observational study, meaning the cause and effect could not be established.
The American Heart Association (AHA) states that hormonal birth control is currently safe for most healthy young females.
Still, Bradley Serwer, MD, an interventional cardiologist and chief medical officer at VitalSolution, a cardiovascular and anesthesiology service, said weighing the risks against the benefits is important.
“If someone is high risk for complications, they may want to consider a safer option,” he told Healthline. Serwer wasn’t involved in the new study.
Serwer added that certain groups of people are known to be at increased risk of complications from hormonal birth control.
“These groups include those that smoke, have pre-existing blood clotting disorders, those with a history of migraines, those with known cardiovascular and peripheral vascular disease, those with obesity, and those with diabetes,” he explained.
Serwer echoed the sentiments of the study authors, highlighting that the absolute risk of hormonal birth control is still very low.
“As a medical professional, we need to sit down with our patients and help them weigh the risks and benefits so that an informed decision can be made,” he said.
Gowri Reddy Rocco, MD, founder and president at Optimum Wellness & Longevity, agreed that any concerns over risks associated with hormonal birth control should be addressed with your primary doctor or OB-GYN. Rocco wasn’t involved in the new study.
“Certain studies have shown that IUDs may be safer with regards to blood clotting, but other studies have shown an increased risk for pelvic infections depending on the individual patient’s lifestyle,” she told Healthline.
Rocco noted that condoms could be “a reasonable choice.” However, they should be avoided if you have a latex allergy.
Other forms of nonhormonal birth control include options such as:
- diaphragms
- sponges
- cervical caps
- spermicides
- contraceptive gels
- fertility awareness
- abstinence
- tubal ligation (having your “tubes tied”)
- vasectomy
Still, certain nonhormonal birth control methods may have their disadvantages. Their effectiveness is variable and may not be as high as hormonal birth control.
Additionally, nonhormonal birth control may require a greater commitment to consistent and proper use. Certain forms of nonhormonal birth control can be quite costly, such as tubal ligation, which is also difficult to reverse.
There may be certain risks depending on what form of nonhormonal birth control you’re using, such as:
- allergy
- irritation
- urinary tract infections (UTIs)
- toxic shock syndrome
“The goal of medical professionals is to have an educated discussion with their patients and help them make the best decisions that best suit their needs while minimizing risk,” Rocco said.