Hormonal contraceptives linked to higher heart risks

A large Danish study published in The BMJ has found that certain hormonal contraceptives can increase the risk of stroke and heart attack.

Globally, an estimated 250 million women use some form of hormonal contraception. To assess whether hormonal contraceptive use increases the risk of first-time stroke and heart attack, researchers tracked national prescription records over 25 years for more than two million Danish women aged 15 to 49. Contraceptives included in the study were oestrogen-progestin pills, vaginal rings, patches, progestin-only pills, intrauterine devices (IUDs), under-the-skin implants and intramuscular injections.

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 from the study.

Women taking the most common hormonal contraceptive, the combined oestrogen/progestin pill, had double the risk of ischaemic stroke or heart attack. Pills and implants containing only progestin were associated with a slightly elevated risk, but lower than that of the combined pills. Vaginal rings containing the oestrogen/progestin combination increased the risk of ischaemic stroke by 2.4-fold and the risk of heart attack by 3.8-fold, while dual hormone skin patches increased ischaemic stroke risk by 3.4-fold. The levonorgestrel-releasing intrauterine device (IUD) was the only contraceptive not linked to a higher risk, regardless of the duration of use.

“Although absolute risks were low, clinicians should include the potential risk of arterial thrombosis in their assessment of the benefits and risks when prescribing hormonal contraceptive methods,” the researchers concluded.

Health