New Study Reveals How Specific Birth Control Methods May Elevate Stroke and Heart Attack Risks
Recent research has highlighted that some hormonal birth control methods could be linked to an increased risk of stroke and heart attack. Understanding these risks is crucial for women considering their contraceptive options. As noted in a comprehensive study, various forms of hormonal contraception, including vaginal rings, skin patches, and combined pills, showed different levels of cardiovascular risk. It’s essential to consult with a healthcare provider to determine the safest method for your individual health needs.
Several forms of hormonal birth control could come with a higher risk for ischemic stroke and heart attack, recent research found.
The study, published in The BMJ on February 12, investigated contraceptive use and cardiovascular risk in over 2 million Danish women.
Compared to those who didn’t use hormonal contraception, women showed the highest risk when using:
- Combined vaginal rings: Increased stroke risk by 2.4-fold and heart attack risk by 3.8-fold.
- Combined skin patches: Increased stroke risk by 3.4-fold.
- Combined oral contraceptive pills: Doubled the risk of stroke and heart attack; this is the most commonly used form of birth control.
Progestin-only contraceptives, such as pills and implants, also showed a slight increase in stroke and heart attack risks, although these were generally lower than the combined methods.
Despite these findings, the researchers emphasized that the risks associated with these contraceptives remain relatively low. “Although hormonal contraception was found to increase cardiovascular risk, the number of women expected to have a heart attack or stroke due to hormonal contraception is still really quite small,” stated Dr. Jennifer Lewey, the director of the Penn Medicine Women’s Cardiovascular Health Program.
Evaluating Contraception and Cardiovascular Risk
This study utilized data collected from 1996 to 2021 involving over 2 million Danish women aged 15 to 49, none of whom had a history of blood clots or other significant health conditions. During the research period, there were:
- 4,730 reported strokes
- 2,072 reported heart attacks
For women not using hormonal birth control, the rate of ischemic stroke was 18 per 100,000 person-years. Comparatively:
- Combined oral birth control pills: 39 strokes per 100,000 person-years
- Progestin-only pills: 33 strokes per 100,000 person-years
- Levonorgestrel-releasing IUDs: 23 strokes per 100,000 person-years
In terms of heart attacks, the incidence rate was:
- 8 per 100,000 person-years for those not using hormonal birth control
- 18 for combined oral contraception users
- 13 for progestin-only pill users
- 11 for IUD users
Interestingly, the study also found that using combined vaginal rings, patches, and, to a lesser extent, progestin-only implants were linked to increased blood clot risks. Essentially, combined pills, rings, and patches, along with progestin pills and implants, showed varying degrees of elevated risk for stroke and heart attacks, while IUDs were noted as having no significant risk.
“The levonorgestrel-releasing intrauterine system was the only hormonal contraceptive not linked to an increased risk, making this option safer for cardiovascular health,” remarked Dr. Therese Johansson, a researcher at the Royal Institute of Technology in Sweden.
Not Quite an Apples-to-Apples Comparison
While the findings from this study are compelling, some limitations should be acknowledged. There is a lack of demographic details regarding the women who experienced adverse health events. Dr. Mary Jane Minkin, a gynecologist at Yale School of Medicine, noted that women in Northern Europe might possess genetic predispositions to blood clot risks, and it’s uncertain how prevalent such mutations are in this population.
Moreover, due to the nature of the study’s design, it’s unclear if hormonal contraceptives directly caused the observed increase in strokes and heart attacks. It’s possible that women prescribed specific forms of birth control had pre-existing health conditions.
“Some providers may believe that a patch or vaginal ring might be safer for women with obesity or older age,” Dr. Minkin added.
Why Does Contraception Affect Cardiovascular Health?
This study is not the first to connect hormonal birth control with cardiovascular risks. A 2012 analysis established a relationship between combined contraceptive pills and stroke and heart attack incidences.
Hormonal compositions in contraceptives likely explain these connections. Dr. C. Noel Bairey Merz explained that estrogen can promote clot formation, while progestogens may lead to the narrowing of blood vessels. However, research findings are mixed; some studies indicate that naturally occurring progesterone can actually enhance blood vessel health.
Factors such as genetics, age, and other underlying health issues also play a role in how hormonal birth control may impact vascular health.
Choosing a Birth Control That’s Right for You
It’s estimated that roughly 65% of American women aged 15 to 49 utilize some form of birth control. With some methods bearing slightly elevated cardiovascular risks, it’s vital to have an open dialogue with your healthcare provider to identify the best option for your health profile.
Overall, birth control is considered safe for many healthy individuals. Interestingly, a large-scale study in 2023 indicated that women using oral contraceptives might actually have a lower risk of cardiovascular diseases and related events.
Nevertheless, women who are older, smoke, or are obese might face higher risks for blood clots. For these individuals, combined hormonal birth control may not be ideal. It’s generally advised against if you have high blood pressure or are over the age of 35.
The specific type of hormonal contraception can also influence risk levels. The patch and ring might present greater risks since they “continuously release low levels of estrogen,” leading to a higher estrogen concentration in the bloodstream.
Alternatives exist outside of combined hormonal methods. Progestin-only options and IUDs can be safer choices for women with existing cardiovascular conditions. Non-hormonal methods, such as condoms and copper IUDs, do not elevate cardiovascular risks. However, these might be less effective.
“Women with existing cardiovascular conditions should work closely with their doctors to assess all contraceptive options, as pregnancy can present significant risks,” cautioned Dr. Lewey.
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