Study Reveals Potential Cardiovascular Risks Linked to Hormonal Contraceptives
The findings from a recent nationwide study suggest that women using certain types of hormonal contraception may face an increased risk of ischemic stroke and heart attack. Specifically, the highest risk estimates were associated with oestrogen-containing products, particularly the vaginal ring and skin patch.
The Absolute Risk Remains Low
While the study reveals these potential risks, it’s crucial to note that the absolute risk remains low. However, given the widespread use of these products and the severity of the conditions involved, healthcare providers should carefully consider these potential risks when prescribing hormonal contraceptives.
Prevalence and Previous Research
Approximately 250 million women worldwide use hormonal contraception. Previous studies have indicated a possible increased risk of ischemic stroke and heart attack from these contraceptives, but results have been inconsistent. Furthermore, little evidence exists on the effects of different hormone combinations, delivery methods, and usage duration.
A Nationwide Study on Hormonal Contraceptives
To address these knowledge gaps, researchers examined the national prescription records of more than two million Danish women aged 15-49 from 1996 to 2021. The objective was to determine if contemporary hormonal contraceptives increased the risk of a first-time ischemic stroke and heart attack compared to non-users. The study included various types of contraception, such as combined oestrogen-progestin pills, vaginal rings, patches, progestin-only pills, intrauterine devices, implants, and injections.
Exclusions were made for women with pre-existing conditions like blood clots, cancer, liver disease, kidney disease, polycystic ovary syndrome, endometriosis, infertility treatment, and those utilizing psychiatric medication, hormone therapy, or who had undergone a hysterectomy. The researchers accounted for factors such as age, education level, and pre-existing medical conditions like high blood pressure and diabetes.
Findings of Increased Risk
The most commonly used hormonal contraceptive, the combined oestrogen-progestin pill, was linked to a doubled risk of ischemic stroke and heart attack. This translates to one additional stroke for every 4,760 women using the combined pill for one year, and one additional heart attack for every 10,000 users annually.
Progestin-only contraceptives, including pills and implants, also carried an elevated risk, though lower than combined pills. Notably, non-oral combined contraceptives, such as the vaginal ring and patch, posed higher risks. The vaginal ring increased the risk of ischemic stroke by 2.4 times and heart attack by 3.8 times, while the patch increased the risk of ischemic stroke by 3.4 times.
Safer Options
The progestin-only intrauterine system was the only method not associated with increased risk, making it a safer option for women concerned about cardiovascular health. Importantly, the study found that the duration of use did not affect the risk profile.
Limitations and Conclusion
As an observational study, definitive cause-and-effect relationships cannot be established, and other unmeasured factors might influence the results. Nevertheless, the robustness of the study, employing high-quality registry data, supports the findings. The researchers concluded that, despite the low absolute risk, clinicians should consider the potential risk of arterial thrombosis when assessing the benefits and risks of hormonal contraceptive methods.
Expert Commentary
Therese Johansson from the Swedish Institute of Technology emphasizes that, although these diseases are rare, especially in young women, the side effects are serious. Given the extensive use of hormonal contraceptives, the implications are significant. She advocates for educational campaigns to empower women with informed choices and stresses the importance of training healthcare providers for consistent, evidence-based counseling.
Johansson further recommends prioritizing the availability and accessibility of safer alternatives, particularly in low-resource settings where cardiovascular risks are often underdiagnosed and untreated.
Call to Action
This study highlights the ongoing need for research and education regarding the risks and benefits of various contraceptive methods. We encourage readers to share their thoughts and experiences in the comments below. Whether you’re a healthcare provider, a woman considering contraception, or simply interested in women’s health, your opinion matters. Don’t forget to subscribe for updates and share this article on social media to start a conversation.