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Are we overestimating the stroke risk related to contraceptive pills?

Gompel, Anne; Plu-Bureau, Genevieve

doi: 10.1097/WCO.0000000000000046

Purpose of review Hormonal contraceptives are used by million of women worldwide. Ischemic stroke is one of the major harmful effects of hormonal contraceptives, but remains a very uncommon disease before menopause. The increased risk of stroke under third and fourth-generation contraceptive pills and nonoral contraceptives has been recently highlighted. Given the benefits associated with combined hormonal contraceptives (COCs), it is important to properly evaluate their risks in order to provide a better benefit/risk balance to young women.

Recent findings Scarce studies addressing the rates of stroke in young women suggest that the fraction attributable to the contraceptive pill remains low. In contrast, there is abundant literature on the relative risks of stroke under COCs. The risk of arterial disease seems to be similar among users of second and third-generation pills, drospirenone-containing pills and nonoral hormonal contraceptives. Progestin-only contraceptives do not appear to be associated with an increased risk of stroke.

Summary New formulations of hormonal contraceptives are not safer than second-generation COCs. Even if the absolute numbers of strokes attributable to hormonal contraceptives is very low, stringent selection of patients should help to reduce the events still more, and progestin-only contraceptives/nonhormonal methods should be preferred in cases of associated risk factors.

Unité de Gynécologie Endocrinienne, Université Paris Descartes, Hôpitaux Universitaires Paris Centre, APHP, Paris, France

Correspondence to Anne Gompel, Unité de Gynécologie Endocrinienne, Hôpitaux Universitaires Cochin-Hôtel-Dieu-Broca, 53, Avenue de l’Observatoire, Paris 75014, France. Tel: +33 1 58 41 35 52; fax: +33 1 58 41 35 78; e-mail:

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