Oral contraceptive, hormone therapy use may increase risk for stroke
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Oral contraceptive use and hormone therapy were associated with an increased risk for stroke, according to study findings published in Stroke.
“Women should be aware of the side effects [of oral contraceptives and hormone therapy] in order to make more informed decisions when it comes to exogenous hormones,” Therese Johansson, MSc, PhD candidate in the department of immunology, genetics and pathology at the Centre for Women’s Mental Health during the Reproductive Lifespan (WOMHER) at Uppsala University, Sweden, told Healio.
In a population-based cohort study, Johansson and colleagues collected data from the UK Biobank that included more than 250,000 women who attended one of 22 assessment centers from 2006 to 2010.
Eighty-one percent of women in the cohort reported use of oral contraceptives. Among participants for whom information about hormone therapy was available, 37% reported using it.
Of 3,007 stroke diagnoses identified, 578 were ischemic stroke, 177 were intracerebral hemorrhage, 478 were subarachnoid hemorrhage and 1,774 were self-reported as stroke of any type and could not be classified.
Event rates of any stroke were increased in the first year of oral contraceptive use (HR = 2.49; 95% CI, 1.44-4.3), but the same was not true during remaining years of use (HR = 1; 95% CI, 0.86-1.14) and after discontinuation (HR = 0.93; 95% CI, 0.84-1.02) compared with nonusers.
Many incidences, however, occurred late in life and the number of events during the first year was small, limiting the possibility of analyses of stroke subtypes for oral contraceptive use.
In the first year of hormone therapy use, there were higher hazard rates of any stroke (HR = 2.12; 95% CI, 1.66-2.7) and cause-specific stroke, such as ischemic stroke (HR = 1.93; 95% CI, 1.05-3.57) and subarachnoid hemorrhage (HR = 2.17; 95% CI, 1.25-3.78) compared with nonuse.
Increased risk for stroke remained during use (HR = 1.18; 95% CI, 1.05-1.31) and after discontinuation (HR = 1.16; 95% CI, 1.02-1.32) of hormone therapy, whereas risks were limited to the first year of oral contraceptive use.
“Women should consult with their health care provider or midwife to discuss which type of contraceptive methods are right for them,” Johansson said in an interview. “If they have additional risk factors, like smoking, a high BMI or genetic predisposition to thrombosis, they should consider another option than estrogen-containing oral pills.”
Johansson told Healio that the next step is to look at larger populations and observe other types and dosages of oral contraceptives and hormone therapies.
“I don’t think that women should stop using oral contraceptives,” Johansson concluded. “But if they’re new users, they should consider which method is best for them based on their individual risk factors.”
For more information:
Therese Johansson, MSc, can be reached at therese.johansson@igp.uu.se.
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