Are hormonal birth control techniques safe for long-term health? For those considering different contraceptive methods, the results of a recent study may help to make informed choices.
Around 250 million women use hormonal contraception. However, studies have shown conflicting results regarding their link with heart attacks and strokes, with some showing increased risk and others suggesting no association or even a protective effect.
To understand the impact of different hormonal birth control choices, researchers of the latest large-scale study evaluated the risk of heart attacks and strokes associated with contraceptive pills, both combined and progestin-only pills, IUDs, implants, injections, vaginal rings, and skin patches.
The study found that both combined hormonal contraceptives (containing estrogen and progestin) and progestin-only methods were linked to an increased risk of ischemic stroke and, in some cases, myocardial infarction. However, levonorgestrel-releasing intrauterine devices (IUDs), such as Mirena, Kyleena, Skyla, and Liletta, did not show an increased risk.
For women using combined birth control pills, the rates of stroke and heart attack were approximately twice as high compared to those who do not use birth control. This means that for every 4,760 women using the pill for a year, there is one additional stroke, and for every 10,000 women, one extra heart attack occurs annually.
However, the risk of stroke and heart attack was lower for those on progestin-only pills, with the risk being about 1.5 times higher compared to non-users.
Other birth control options such as vaginal rings, skin patches, and progestin-only implants also carried increased risks for ischemic stroke compared to non-users. While the vaginal ring raised the risk of stroke by 2.4 times and heart attack by 3.8 times, the skin patch was associated with a 3.4 times higher risk of stroke, though there was no increased risk of heart attack. The progestin-only implant showed a 2.1 times higher risk for stroke, with a smaller increase in the risk of heart attack.
"Although absolute risks were low, clinicians should include the potential risk of arterial thrombosis in their assessment of the benefits and risks when prescribing a hormonal contraceptive method," the researchers wrote.
The researchers recommend that the choice of a hormonal contraceptive should be based on personalized contraceptive counseling. This would help take into account individual risk factors, such as age, and existing health conditions like hypertension, obesity, and smoking, all of which can amplify the risk of stroke and heart attack.
