Association between oral contraceptives and risk of hemorrhagic stroke: a meta-analysis of observational studies
Abstract
Objectives To estimate the risk of hemorrhagic stroke associated with current use of oral contraceptives (OCs), and to further depict how the risk was affected by study characteristics.Methods We searched PubMed, Embase, and Cochrane Library for relevant articles published up to February 2017 that examined the association between OC use and risk of hemorrhagic stroke. Two investigators independently reviewed articles based on inclusion criteria. The Newcastle-Ottawa scale was employed to evaluate quality of studies. Random-effects meta-analysis model was used to generate summary risk estimates.Results Fifteen independent studies (5 cohort studies and 10 case-control studies) with 4271 hemorrhagic stroke cases were included in this meta-analysis. The overall summary odds ratio (OR) for hemorrhagic stroke (HS) in relation to current OC use was 1.39 [95% confidence interval (CI), 1.05-1.83]. Subgroup analyses on hemorrhagic stroke types showed that OC use was associated with subarachnoid hemorrhage (SAH) (OR 1.68; 95% CI 1.21-2.12), but not with intracerebral hemorrhage (ICH) (OR 0.92; 95% CI 0.33-2.54). The risk of hemorrhagic stroke was increased slightly among current OC users with high-dose estrogen (OR 1.60; 95% CI 1.12-2.27). The risk of hemorrhagic stroke was further increased in OC users with additional risk factors including current smoking, hypertension, and history of migraine.Conclusions This meta-analysis of observational studies suggests that current use of OCs could contribute to a small increased risk of hemorrhagic stroke, and the increased risk is related to subarachnoid hemorrhage, but not intracerebral hemorrhage.
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The increase in stroke risk for current users of any oral contraceptive is greater for ischaemic stroke than for haemorrhagic stroke.
“The increase in risk was greater for ischaemic stroke67 than haemorrhagic stroke.71”
From Association between the reproductive health of young women and cardiovascular disease in later life: umbrella review (2020) · cites this paper as [71]
Current users of any oral contraceptive have an increased risk of stroke compared with non-current users.
“Current users of any oral contraceptive (combined oral contraceptives containing a combination of oestrogen and progesterone, or progesterone only pill) had an increased risk of stroke compared with non-current users.67 71”
From Association between the reproductive health of young women and cardiovascular disease in later life: umbrella review (2020) · cites this paper as [71]
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- Authors
- Xu, Z., Yue, Y., Bai, J., Shen, C., Yang, J., Huang, X., Zhao, Y., & Li, Y.
- Affiliations
- Hohai University (CN)
- Nanjing Medical University (CN)
- Nanjing Municipal Center for Disease Control And Prevention (CN)
- Corresponding author
- Zhao, Yang
- Li, Ying
- Venue
- Archives of Gynecology and Obstetrics
- Published
- 2018-02-19
- Volume
- 297
- Issue
- 5
- Pages
- 1181-1191
- ISSN
- 0003-9128 (ISSN-L)
- 0932-0067
- 1432-0711
- OpenAlex
- W2791325973
- Cited by
- 31
- References
- 42
- Citations by year
- 2026: 2 · 2025: 6 · 2024: 3 · 2023: 5 · 2022: 6 · 2021: 4 · 2020: 3 · 2019: 2
- FWCI
- 0.35
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Archives of Gynecology and Obstetrics (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Natural Science Foundation of China (81573227, 81373102, 81573232)
- Ministry of Science and Technology of the People's Republic of China (2006BAI15B07)
- Top-notch Academic Programs Project of Jiangsu Higher Education Institutions (PPZY2015A067)
- the Qing-lan Project of Jiangsu Province and the Priority Academic Program Development of Jiangsu Higher Education Institution
- Topics
- Health Sciences › Medicine › Neurology › Intracerebral and Subarachnoid Hemorrhage Research
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Health and Contraception
- Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
- Keywords
- oral contraceptives, hemorrhagic stroke, subarachnoid hemorrhage, intracerebral hemorrhage, estrogen dose, smoking, hypertension, migraine, stroke risk factors
- MeSH terms
- Adult, Cerebral Hemorrhage, China, Estrogens, Female, Humans, Risk Factors, Subarachnoid Hemorrhage, Prevalence, Stroke, Observational Studies as Topic
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