Ischemic Stroke: Birth Control Increases Risk | News | Loyola Medicine
Thursday, March 15, 2018

Birth Control Pills Increase Risk of Ischemic Stroke

 
MAYWOOD, IL – Oral contraceptives increase the risk of ischemic stroke, but this risk is very small among women who do not have other stroke risk factors, according to a comprehensive review in the journal [216.246.0269]MedLink Neurology by Loyola Medicine stroke specialists.
 
Birth control pills do not increase the risk of hemorrhagic strokes, wrote neurologists Sarkis Morales-Vidal, MD, and José Biller, MD. Ischemic strokes, which account for about 85 percent of all strokes, are caused by blood clots. Hemorrhagic strokes are caused by bleeding in the brain.
 
Several mechanisms have been proposed to explain why oral contraceptives increase stroke risk, including by raising blood pressure and by making blood hypercoagulable (more likely to clot).
 
When prescribing hormonal contraceptives, physicians should consider the type and dose of estrogen or progestin and route of administration (such as pill or patch). "The ideal drug is one with the lowest estrogen and progestin doses that will be effective in preventing pregnancy while minimizing adverse effects," Drs. Morales and Biller wrote.
 
For healthy young women without any stroke risk factors, the stroke risk associated with oral contraceptives is very small.
 
"However, in women with other stroke risk factors, the risk seems higher and, in most cases, oral contraceptive use should be discouraged," Drs. Morales and Biller wrote. These risk factors include high blood pressure, cigarette smoking and migraine headaches, especially migraines with sensory disturbances called aura (such as flashes of light and tingling in the hands or face).
 
However, women may not always be adequately screened. One previous study found that, among women with one or more stroke risk factors, only 15 percent recalled being advised not to start oral contraceptives and only 36 percent remembered being told to stop. Fifteen percent of women were still taking oral contraceptives despite being told to discontinue. These findings highlight the need to improve physician counseling and patient compliance, Drs. Morales and Biller wrote.
 
Their report is titled “Hormonal Contraception and Stroke.” It is an update of a report originally published in Medlink Neurology in 2003.
 
Dr. Morales is an associate professor and Dr. Biller is a professor and chair of the department of neurology of Loyola University Chicago Stritch School of Medicine.
 

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Loyola Medicine, a member of Trinity Health, is a quaternary care system based in the western suburbs of Chicago that includes Loyola University Medical Center (LUMC), Gottlieb Memorial Hospital, MacNeal Hospital and convenient locations offering primary and specialty care services from 1,877 physicians throughout Cook, Will and DuPage counties. LUMC is a 547-licensed-bed hospital in Maywood that includes the William G. and Mary A. Ryan Center for Heart & Vascular Medicine, the Cardinal Bernardin Cancer Center, a Level 1 trauma center, Illinois's largest burn center, a certified comprehensive stroke center and a children’s hospital. Having delivered compassionate care for over 50 years, Loyola also trains the next generation of caregivers through its teaching affiliation with Loyola University Chicago’s Stritch School of Medicine and Marcella Niehoff School of Nursing. Gottlieb is a 247-licensed-bed community hospital in Melrose Park with 150 physician offices, an adult day care program, the Gottlieb Center for Fitness, the Loyola Center for Metabolic Surgery and Bariatric Care and the Loyola Cancer Care & Research at the Marjorie G. Weinberg Cancer Center at Melrose Park. MacNeal Hospital is a 374-bed teaching hospital in Berwyn with advanced inpatient and outpatient medical, surgical and psychiatric services, advanced diagnostics and treatments. MacNeal has a 12-bed acute rehabilitation unit, a 25-bed inpatient skilled nursing facility, and a 68-bed behavioral health program and community clinics. MacNeal has provided quality, patient-centered care to the near west suburbs since 1919.

Trinity Health is one of the largest multi-institutional Catholic healthcare systems in the nation, serving diverse communities that include more than 30 million people across 22 states. Trinity Health includes 94 hospitals, as well as 109 continuing care locations that include PACE programs, senior living facilities and home care and hospice services. Its continuing care programs provide nearly 2.5 million visits annually. Based in Livonia, Mich., and with annual operating revenues of $18.3 billion and assets of $26.2 billion, the organization returns $1.1 billion to its communities annually in the form of charity care and other community benefit programs. Trinity employs about 133,000 colleagues, including 7,800 employed physicians and clinicians. Committed to those who are poor and underserved in its communities, Trinity is known for its focus on the country's aging population. As a single, unified ministry, the organization is the innovator of Senior Emergency Departments, the largest not-for-profit provider of home health care services—ranked by number of visits—in the nation, as well as the nation’s leading provider of PACE (Program of All Inclusive Care for the Elderly) based on the number of available programs.