In a groundbreaking study presented at the European Stroke Organisation Conference (ESOC) 2025 in Helsinki, researchers have found a striking link between the use of combined oral contraceptives and an increased risk of cryptogenic stroke in young women. The findings raise fresh concerns over the safety of hormonal contraceptives, especially in individuals already carrying underlying risk factors for vascular disease.
What Is a Cryptogenic Stroke?
A cryptogenic stroke is a type of ischemic stroke in which the underlying cause cannot be identified, even after thorough medical evaluation. It is surprisingly common, accounting for up to 40% of all ischemic strokes in young adults. These strokes are often sudden, debilitating, and difficult to predict, making them particularly concerning for otherwise healthy individuals.
The Study at a Glance
Conducted across 14 medical centres in Europe, the study involved 268 women aged 18 to 49 who had suffered a cryptogenic ischemic stroke. These women were compared with 268 age-matched control participants who had no history of stroke. Among the participants, 66 stroke patients and 38 controls reported using combined oral contraceptives, which include both oestrogen and progestin.
The analysis revealed that women using these contraceptives were approximately three times more likely to experience a cryptogenic stroke than those who were not. Even after adjusting for common stroke risk factors such as smoking, hypertension, and family history, the link between contraceptive use and stroke remained robust.
A Growing Concern in Women’s Health
While previous studies have pointed to an increased risk of stroke from oral contraceptives, this new research adds a critical layer by focusing specifically on cryptogenic strokes—a form of stroke still shrouded in medical mystery.
“What’s particularly notable is that the association remains strong even when accounting for other known risk factors,” said Dr. Mine Sezgin, lead author of the study and a neurologist at Istanbul University. “This suggests there may be additional mechanisms involved – possibly genetic or biological – that need to be further investigated.”
The findings contribute to a growing body of literature questioning the vascular safety profile of hormonal contraceptives, particularly those containing both estrogen and progestin.
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Clinical Implications: A Call for Caution
Given the results, experts urge healthcare providers to take a more cautious approach when prescribing combined oral contraceptives, especially to women with a history of stroke or other cardiovascular risk factors.
“Clinicians should be vigilant in evaluating each patient’s individual risk profile,” said Dr. Sezgin. “This is not about creating fear, but about making informed choices based on emerging evidence.”
The study’s authors also emphasised that further research is necessary to unravel the genetic and biological mechanisms behind this elevated stroke risk. Understanding these pathways could lead to safer contraceptive options and better screening tools in the future.
What This Means for Women
If you are currently using combined oral contraceptives or considering starting them, it’s essential to have a conversation with your healthcare provider about your personal risk factors. While these pills are a reliable form of birth control and offer several benefits, including regulating menstrual cycles and reducing acne, the potential for serious side effects, such as stroke, should not be overlooked.
Women with migraines, high blood pressure, a family history of stroke, or smoking habits may need to consider alternative forms of contraception.
Bottomline
The research team plans to delve deeper into the biological and genetic foundations of the link between contraceptive use and cryptogenic stroke. Their ultimate goal is to develop personalised contraceptive guidelines that take an individual’s vascular risk into account.
Until then, this study serves as a timely reminder: when it comes to women’s health, one-size-fits-all approaches often fall short. Tailored, evidence-based care remains the key to safer and more effective contraceptive use.