New Delhi: Women who use a combined oral contraceptive (COC)—better known as the pill—are three times more likely to suffer an unexpected stroke than those who don’t. These new findings were presented at a conference of European Stroke Organisation in Finland’s Helsinki on May 20.The pill is a hormonal contraceptive, containing both oestrogen and progestogen, which prevents the ovaries from releasing an egg each month. A research at Istanbul University in Turkiye has established the connection between cryptogenic ischaemic stroke (CIS) and oral contraceptives. The research analysed 268 women, aged 18 to 49 years, who experienced unexpected strokes, comparing them with 268 women in the similar age group without a stroke history.Studies from 2019 and 2022 highlighted similar concerns. The discovery of direct vascular effects of COCs requires immediate attention. Healthcare professionals acknowledge that extended usage periods and increased oestrogen levels heighten stroke risks.Dr Anuradha Kapur, principal director (obstetrics & gynaecology) and head of the unit at Max Smart Super Specialty Hospital, Saket, pointed out that while medicines could notably raise the likelihood of ischaemic strokes, they typically required existing risk elements to cause harm. “Think of it as adding gasoline to a fire that has not yet been lit. If you have a genetic factor or already have a risk factor, the pill can be the trigger,” she clarified.However, research findings demonstrated that the increased stroke risk associated with oral contraceptive use appears to operate independently, as no significant associations were found between contraceptive usage and other documented risk factors.“Our findings confirm earlier evidence linking oral contraceptives to stroke risk,” said Dr Mine Sezgin of the neurology department at Istanbul University and the lead author of the study. “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.”Dr Renu Gupta, director of obstetrics and gynaecology at Sri Balaji Action Medical Institute Delhi, emphasised that stroke resulted from multiple factors, including genetic, physiological and lifestyle-related risks. She noted that COC could trigger complications in women with underlying health conditions, including undiagnosed thrombophilias or autoimmune conditions.While the researchers note that further prospective studies are needed, they advise clinicians to exercise caution when prescribing the pill to women with known vascular risk factors or a history of ischaemic stroke.Describing the connection between oral contraceptives and stroke, prof Manjari Tripathi, head of the neurology department at AIIMS, explained that COC usage consistently correlated with increased ischaemic stroke risk, particularly in women with pre-existing health risk factors. COC usage increases ischaemic stroke risk by 1.6 to 2 times, with higher risks in women experiencing migraines with aura. The risk intensifies for women who smoke, have high blood pressure, migraines with aura, or a stroke history.The oestrogen component potentially increases blood coagulability and clot formation.Dr Vinit Suri, senior consultant of neurology at Indraprastha Apollo Hospitals, noted that first-year usage presented the highest risk, affected by oestrogen dosage. Modern pills contain lower oestrogen levels, reducing risks compared to older formulations, he pointed out. Risk increases with smoking, hypertension or age above 35. Healthy young women face minimal absolute risk, with pregnancy presenting higher stroke risks than oral contraceptives.“The real risk lies in stacking oestrogen on top of other vascular triggers—smoking, uncontrolled hypertension or migraine with aura—where non-oestrogen methods are clearly the wiser bet,” said Dr Bhaskar Shukla, consultant neurologist at PSRI Hospital. Informed choice, annual check-ups and the growing menu of highly effective LARC devices mean women no longer have to trade peace of mind for modern contraception, he added.
