Reproductive History, Oral Contraceptive Use, and the Risk of Ischemic and Hemorrhagic Stoke in a Cohort Study of Middle-Aged Swedish Women

Yang, Ling; Kuper, Hannah; Sandin, Sven; Margolis, Karen L.; Chen, Zhengming; Adami, Hans Olov; Weiderpass, Elisabete

doi:10.1161/strokeaha.108.531913

Cited by 49 publications

(39 citation statements)

References 25 publications

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“…This cohort comprised 49 259 Swedish women who were followed up from 1991 to 1992 until 2004. 219 In the 285 cases of incident stroke that included ischemic, hemorrhagic, and unknown types, there was no significant association between OC use, duration, or type of OC. Reproductive factors, such as age at first birth, duration of breastfeeding, age at menarche, mean menstrual cycle days at age 30 years, and parity, were not associated with stroke after adjustment for cigarette smoking, hypertension, diabetes mellitus, alcohol, body mass index (BMI), education, and physical activity.…”

Section: Oral Contraceptivesmentioning

confidence: 95%

Guidelines for the Prevention of Stroke in Women

Bushnell¹,

McCullough²,

Awad³

et al. 2014

Stroke

768

414

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1545Purpose-The aim of this statement is to summarize data on stroke risk factors that are unique to and more common in women than men and to expand on the data provided in prior stroke guidelines and cardiovascular prevention guidelines for women. This guideline focuses on the risk factors unique to women, such as reproductive factors, and those that are more common in women, including migraine with aura, obesity, metabolic syndrome, and atrial fibrillation. Results-We provide current evidence, research gaps, and recommendations on risk of stroke related to preeclampsia, oral contraceptives, menopause, and hormone replacement, as well as those risk factors more common in women, such as obesity/metabolic syndrome, atrial fibrillation, and migraine with aura. Conclusions-To more accurately reflect the risk of stroke in women across the lifespan, as well as the clear gaps in current risk scores, we believe a female-specific stroke risk score is warranted. (Stroke. 2014;45:1545-1588.)

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Section: Oral Contraceptivesmentioning

confidence: 95%

Guidelines for the Prevention of Stroke in Women

Bushnell¹,

McCullough²,

Awad³

et al. 2014

Stroke

768

414

View full text Add to dashboard Cite

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“…Arterial thrombosis: myocardial infarction and stroke Modern COCs containing less than 50 µg of EE do not increase the risk of myocardial infarction or stroke in healthy, nonsmoking women regardless of age [WHO, 1996[WHO, , 1997Margolis et al 2007;Yang et al 2009]. However, if hypertension is present, the woman may run an increased risk and thus COC use should be avoided in women with hypertension.…”

Section: Acquired Risk Factorsmentioning

confidence: 99%

Combined hormonal contraceptives: prescribing patterns, compliance, and benefits versus risks

Brynhildsen

2014

Therapeutic Advances in Drug Safety

123

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Combined hormonal contraceptives [combined oral contraceptives (COCs)] have been available for over 50 years and the impact of this invention may not be overestimated. Today over 100 million women are current users and in Western Europe and the United States approximately 80% of women of fertile ages can be considered as ever-users. Over the years several drawbacks have been identified and media alarms on risks are frequently presented, resulting in suboptimal compliance and low compliance and continuation rates. Poor compliance and discontinuation is a big problem and is not generally identified by prescribers. During ideal use COCs offer very good protection against unwanted pregnancies, however there is a big problem with compliance and continuation and thus the 'real-life' efficacy is much lower. Reasons for poor compliance include side effects and fear of side effects and it is crucial that the prescriber gives the individual woman thorough and balanced information on the benefits and risks. Most well known is the increased risk of venous thromboembolism, but also an elevated risk of arterial thrombosis and several types of cancer has been reported. The risk estimates are low but according to the large number of users a substantial number of extra cases will occur. However, use of COCs also offers several additional health benefits with significant impact on morbidity and quality of life. COC use is associated with a substantial decrease in the risk of ovarian cancer, endometrial cancer and colorectal cancer. Moreover, COCs are a major option of treatment for women suffering from heavy menstrual bleeding and dysmenorrhea as well as hirsutism and acne vulgaris. The net effect of the additional health effects of COC-use may very well be positive, i.e. a slight increase in life expectancy.

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“…Regarding the use of COCs and types of stroke, two cohort studies showed divergent results, even with a high sample (25,27) . In the study conducted in China, 44,408 COC users were followed between 1997-2000, with a relative risk of hemorrhagic stroke of 3.6; regarding ischemic stroke, there was no difference.…”

Section: Discussionmentioning

confidence: 99%

“…Regarding the study developed in Sweden, 45,729 women were followed between 1991-2004, showing that COC users were not exposed to the risk of stroke, considering a Relative Risk <1. Follow-up occurred through telephone calls through national health registries (27) . Even though the investigation was conducted during a smaller period, the first study showed a higher risk when compared to the second.…”

Section: Discussionmentioning

confidence: 99%

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Influence of hormonal contraceptives and the occurrence of stroke: integrative review

et al. 2017

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Objective: To identify scientifi c evidence regarding the infl uence of hormonal contraceptive use and the occurrence of stroke. Method: Integrative review of the literature, through database search using the descriptors "contraceptive agents", "contraceptive devices", "contraceptives, Oral" and "Stroke". Original studies in Portuguese, Spanish and English, published in full and available online were included. Studies that did not answer our guiding questions and duplicated studies were excluded. Results: Women using combined oral contraceptives have higher risk of stroke, even with a lower hormonal dosage and different types of progestogen, regardless of the duration of use. The use of contraceptives associated with smoking, hypertension, migraine, hypercholesterolemia, obesity and sedentary lifestyle increases the chance of stroke. Contraceptive patch and vaginal ring are associated to increased risk. Conclusion: Use of combined hormonal contraceptives, except for the injectable and the transdermal ones, increases the chance of occurrence of the event. Progestogen-only contraceptives were considered safe. Descriptors: Stroke; Contraceptives; Contraceptive Devices; Oral Contraceptives; Nursing. RESUMO Objetivo: Identifi car evidências científi cas acerca da infl uência do uso de anticoncepcionais hormonais na ocorrência do acidente vascular cerebral (AVC). Método: Revisão integrativa da literatura, com pesquisa em bases de dados, utilizando os descritores "contraceptive agents", "contraceptive devices", "contraceptives, Oral" e "stroke". Foram incluídos artigos originais nos idiomas português, espanhol e inglês, publicados na íntegra e disponíveis eletronicamente. Foram excluídos artigos que não respondiam às questões norteadoras e repetidos. Resultados: Usuárias de anticoncepcional oral combinado apresentam risco maior de AVC, mesmo com dosagem hormonal menor e diferentes tipos de progestágeno, independente do tempo de uso. A presença associada de tabagismo, hipertensão arterial, enxaqueca, hipercolesterolemia, obesidade e sedentarismo aumenta a chance desse desfecho. Adesivo anticoncepcional e anel vaginal são relacionados ao aumento desse risco. Conclusão: A exposição aos anticoncepcionais hormonais combinados aumenta a chance de ocorrência do evento, exceto o injetável e o transdérmico. Os exclusivos de progestágeno foram considerados seguros. Descritores: Acidente Vascular Cerebral; Anticoncepcionais; Dispositivos Anticoncepcionais; Anticoncepcionais Orais; Enfermagem. RESUMEN Objetivo: Estudiar las evidencias científi cas acerca de la infl uencia del uso de anticonceptivos hormonales en el acaecimiento de accidentes cerebrales vasculares (ACV). Método: Revisión integradora de la literatura, realizada mediante investigación científi ca en bases de datos, utilizando los descriptores "anticonceptivos", "dispositivos anticonceptivos", "anticonceptivos orales" y "derrame cerebral". Se incluyeron artículos originales en los idiomas portugués, español e inglés, publicados en su totalidad y disponibles e...

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Reproductive History, Oral Contraceptive Use, and the Risk of Ischemic and Hemorrhagic Stoke in a Cohort Study of Middle-Aged Swedish Women

Cited by 49 publications

References 25 publications

Guidelines for the Prevention of Stroke in Women

Guidelines for the Prevention of Stroke in Women

Combined hormonal contraceptives: prescribing patterns, compliance, and benefits versus risks

Influence of hormonal contraceptives and the occurrence of stroke: integrative review

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