ESOC 2025 | Hormonal contraception and stroke risk: what we know and what remains unclear

So in many studies we showed that the hormonal contraceptives increased the risk of ischemic stroke and also cryptogenic ischemic stroke in young females. So the current evidence says that the increased risk is somehow high but we are not sure about that because there are too many different results from different studies. So, but we can say it’s increased like three times or 2.5 times. As neurologists, we encounter patients who already had a stroke and they came to us with a non-stroke history. So when we see that kind of patient, we can say hormonal contraception increases the risk of your stroke so it may be good to stay away from that, but always we need to weigh the pros and cons for patients. From the evidence from recent studies, some only progesterone drugs may be safer or compared to the estrogen-only drugs. So maybe that can be an option for women who had a stroke before. We definitely don’t know much about that hormonal contraceptives and ischemic stroke, because we don’t know the stroke features. I mean, the clinical and demographical features of a person who had a stroke while they are on hormonal contraceptives, and also we don’t know the recurrences. Usually, they don’t continue to use hormonal contraceptives, but we don’t know the recurrence risk for ischemic stroke, so I think that question should be answered.

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