As popular as birth control is, these products aren’t without their risks. There is a lot of misinformation out there about how oral birth control relates to your risk of stroke. Here, Natasha Prince, M.D., an obstetrician and gynecologist at Henry Ford Health, breaks down how your stroke risk and birth control choices are related and what you can do about it.
How Birth Control Impacts Your Stroke Risk
Decades ago, the doses of estrogen in birth control were much higher than they are today. These high doses of estrogen contributed to an increased risk of stroke.
“Doctors today typically prescribe birth control with 10-35mcg (micrograms) of estrogen compared to many products in the past that contained up to 50mcg of estrogen,” says Dr. Prince. “With modern birth control doses, there is statically no difference in stroke risk for healthy low risk patients on birth control versus patients who are not.”
Today, there are two types of hormonal birth control pills: combination birth control pills that contain estrogen and progesterone, and other pills that only contain progesterone. It is the estrogen in combination birth control pill that are responsible for an increased risk of stroke in some women.
The reason? Estrogen impacts blood-clotting proteins in the body. These proteins are needed to balance your blood between being too thick or too thin. Added estrogen creates a difference in this balance that can increase the clotting ability of your blood – increasing your risk for stroke.
In general, the risk of stroke while on estrogen-containing birth control is approximately 8 in 100,000 people.
“There is a lot of fear around this risk and many patients might be skeptical about using birth control for this reason,” says Dr. Prince. “The reality is, your risk of stroke from your birth control is actually lower than the risk of stroke during pregnancy, so it is really all about perspective and weighing your risks verses benefits.”
What Increases Your Risk Of Stroke On Birth Control?
Women's Health At Henry Ford
There are, however, a few risk factors that would make you more susceptible to a stroke while taking birth control. This includes, but is not limited to, women who:
- Are over age 35 and smoke
- Have a history of high blood pressure
- Have a history of blood clotting disorders
- Have a history of migraines with an aura
“If you have any of these risk factors, the risk of a stroke outweighs the benefits of estrogen containing birth control,” says Dr. Prince. “For example, women who have migraines with aura are thought to have narrowing of the blood vessels in their brain which increases the tendency to form a blood clot and cause a stroke.”
The Centers for Disease Control (CDC) provides a list of medical eligibility criteria that providers use to understand how risks associated with different contraceptives can be impacted by other prescriptions you take or health conditions you have.
Talking To Your Provider About Birth Control Options
If you are interested in exploring your options for birth control or would like to understand your risk of stroke associated with birth control, make an appointment to talk with your OB/GYN. Your doctor can provide contraceptive counseling and address any concerns or health needs you have.
When prescribing birth control, your health care provider will make sure to go through your detailed medical history to avoid prescribing if you have known risk factors of stroke. Additionally, you’ll be re-evaluated each year to make sure that your health hasn’t changed in a way that would impact your current birth control choice.
“If you are concerned about your stroke risk related to your hormonal birth control use, don’t worry,” advises Dr. Prince. “There are many progesterone-only and non-hormonal options available to patients.” Your doctor can work with you to determine which option might be right for you.
Reviewed by Dr. Natasha Prince, an OB/GYN who sees patients at Henry Ford Medical Center – Detroit Northwest.
