Experts have warned that certain medical interventions that women are exposed to, such as the birth control pill or treatment involving hormone therapy for post-menopausal women, can contribute to a woman’s risk of developing stroke.
According to the AHA Journals, a publication of the American Heart Association, in prospective cohort studies, data suggest that post-menopausal users of oral estrogens with or without progestin have a 27% to 39% increased risk of stroke, compared with nonusers.
In general, high blood pressure is the leading cause of stroke and is the main cause for increased risk of stroke among people with diabetes.
The female body produces estrogen, which is what makes someone female, to start with. Also, during pregnancy, estrogen levels steadily climb and increases production of clotting factors, which may account for the increased risk of stroke in women in the period shortly before, during, or immediately after giving birth [peripartum period], says a 2012 research published by online portal, the National Institutes of Health.
Although the majority of stroke incidence can be attributed to traditional vascular risk factors that occur in both men and women, including hypertension, hyperlipidemia [elevated concentrations of lipids or fats within the blood], diabetes, smoking, and irregular pulse rate, there are several stroke risk factors that are specific to women.
While physicians agree that the major risk factors for stroke include high blood pressure. diabetes, heart and blood vessel diseases, conditions that can cause blood clots or other blockages include coronary heart disease, atrial fibrillation, heart valve disease, and carotid artery disease;
However, researchers at the NIH say that natural and synthetic estrogen may cause the following common adverse effects: breast tenderness, nausea, vomiting, bloating, stomach cramps, headaches, weight gain, hyperpigmentation of the skin, hair loss, vaginal itching, abnormal uterine bleeding, also known as breakthrough bleeding, and anaphylaxis — that is a situation whereby the blood pressure drops suddenly and the airways narrow, blocking breathing. Signs and symptoms include a rapid, weak pulse; a skin rash; and nausea and vomiting.
While progestogen-only hormonal contraceptives have not been associated with increased risk of ischemic stroke although data are limited, non-oral methods of delivering combined hormonal contraceptives, including the vaginal ring and contraceptive patches, seem to have the same risk as oral contraceptives.
According to the World Health Organisation, hormonal contraceptives are used by millions of women, and for most low-risk women, the risk of stroke associated with combined oral contraceptive pill [which has both estrogen and progestogen] is lower than the risk of stroke during pregnancy.
However, there is a clear association between hormone-containing birth control methods and ischemic stroke.
“This is magnified by stroke risk factors. Although a combined oral contraceptive pill containing 30 μg of estrogen is considered safe and effective hormonal contraception, careful attention to stroke risk should be made before prescribing,” WHO warns.
Non-hormonal and progestogen-only methods of contraception should also be considered in high-risk patients, WHO says; warning that further research to evaluate the risk of progestogen-only methods (depot injection, pills, implants, and intrauterine devices) is needed.
Stroke prevention
Risk of stroke with COC use rises in the presence of other cardiovascular risk factors (ie, smoking, age [>35 years], and history of migraine with aura)
Many stroke prevention strategies are the same as strategies to prevent heart disease. In general, healthy lifestyle recommendations include:
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- Control high blood pressure (hypertension)
- Lower the amount of cholesterol and saturated fat in your diet
- Quit tobacco use
- Manage diabetes through good dietary habit
- Exercise regularly and lose weight
- Maintain a healthy weight
- Eat a diet rich in fruits and vegetables
- Drink alcohol in moderation, if at all
- Treat obstructive sleep apnea — a sleep disorder that causes you to stop breathing for short periods repeatedly during sleep;
- Avoid illegal drugs such as cocaine and methamphetamine.
The bottom line: As a menopausal or postmenopausal woman, don’t engage in self medication. Work closely with your doctor as you manage this important stage of your life.
As a young woman of reproductive age, work with your doctor who will advise you on the appropriate birth control method, based on your health peculiarity.
