Oral Contraceptives and Stroke Risk
Oral Contraceptives and Stroke Risk
Abstract & Commentary
Frank W. Ling, MD, Women’s Health Specialists, PLLC, Memphis, Tennessee, is Associate Editor for OB/Gyn Clinical Alert
Synopsis: The risk for stroke among users of low-dose oral contraceptives is less than commonly cited and may not even exist at all.
Source: Chan WS, et al. Arch Intern Med. 2004;164:741-747.
This meta-analysis of 36 articles culled from a pool of 779 publications included 20 different populations. Four were cohort studies and 16 were case-controlled. Among the cohort studies, the pooled odds ratio (OR) showed no increased risk of stroke with oral contraceptive use. The pooled OR from the case-controlled studies did demonstrate a significant association. These findings were related to thrombotic stroke, but not to hemorrhagic stroke or death due to a stroke. Methodological flaws were identified by Chan and colleagues, with a particular focus on the case-controlled studies. It was the conclusion of Chan et al that the true association between low-dose oral contraceptives and stroke was no better than tenuous, and potentially even non-existent.
Comment by Frank W. Ling, MD
It’s interesting, but appropriate, that this article comes out of the internal medicine peer-reviewed literature. Maybe it’s different for you, but in my practice, it is not insignificant time that I spend counseling patients about whether they are or are not appropriate candidates for low-dose oral contraceptives. Much of a patient’s knowledge of what she should avoid comes from providers in other specialties, not obstetrics and gynecology. The stroke risk that is sometimes cited comes from a time when the pills had significantly higher hormonal content. It may well be that there are patients who are steered away from an effective and safe method of contraception when their risk is, in fact, less than previously thought.
There is no question that a high-risk group still exists, specifically women older than 35 years of age who are also smokers. Caution should also be exercised in women with hypertension and diabetes, but, once again, individualized decisions should be reached in light of each patient’s unique circumstances. Healthcare providers who do not deal with very many high-risk populations may not be fully cognizant of the risk data, or may apply data in an extremely narrow fashion.
This meta-analysis of 36 articles culled from a pool of 779 publications included 20 different populations. Four were cohort studies and 16 were case-controlled. Among the cohort studies, the pooled odds ratio (OR) showed no increased risk of stroke with oral contraceptive use.Subscribe Now for Access
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