Influence of hormonal contraceptives and the occurrence of stroke: integrative review

Abstract

Objective: To identify scientifi c evidence regarding the infl uence of hormonal contraceptive use and the occurrence of stroke. Method: Integrative review of the literature, through database search using the descriptors "contraceptive agents", "contraceptive devices", "contraceptives, Oral" and "Stroke". Original studies in Portuguese, Spanish and English, published in full and available online were included. Studies that did not answer our guiding questions and duplicated studies were excluded. Results: Women using combined oral contraceptives have higher risk of stroke, even with a lower hormonal dosage and different types of progestogen, regardless of the duration of use. The use of contraceptives associated with smoking, hypertension, migraine, hypercholesterolemia, obesity and sedentary lifestyle increases the chance of stroke. Contraceptive patch and vaginal ring are associated to increased risk. Conclusion: Use of combined hormonal contraceptives, except for the injectable and the transdermal ones, increases the chance of occurrence of the event. Progestogen-only contraceptives were considered safe. Descriptors: Stroke; Contraceptives; Contraceptive Devices; Oral Contraceptives; Nursing. RESUMO Objetivo: Identifi car evidências científi cas acerca da infl uência do uso de anticoncepcionais hormonais na ocorrência do acidente vascular cerebral (AVC). Método: Revisão integrativa da literatura, com pesquisa em bases de dados, utilizando os descritores "contraceptive agents", "contraceptive devices", "contraceptives, Oral" e "stroke". Foram incluídos artigos originais nos idiomas português, espanhol e inglês, publicados na íntegra e disponíveis eletronicamente. Foram excluídos artigos que não respondiam às questões norteadoras e repetidos. Resultados: Usuárias de anticoncepcional oral combinado apresentam risco maior de AVC, mesmo com dosagem hormonal menor e diferentes tipos de progestágeno, independente do tempo de uso. A presença associada de tabagismo, hipertensão arterial, enxaqueca, hipercolesterolemia, obesidade e sedentarismo aumenta a chance desse desfecho. Adesivo anticoncepcional e anel vaginal são relacionados ao aumento desse risco. Conclusão: A exposição aos anticoncepcionais hormonais combinados aumenta a chance de ocorrência do evento, exceto o injetável e o transdérmico. Os exclusivos de progestágeno foram considerados seguros. Descritores: Acidente Vascular Cerebral; Anticoncepcionais; Dispositivos Anticoncepcionais; Anticoncepcionais Orais; Enfermagem. RESUMEN Objetivo: Estudiar las evidencias científi cas acerca de la infl uencia del uso de anticonceptivos hormonales en el acaecimiento de accidentes cerebrales vasculares (ACV). Método: Revisión integradora de la literatura, realizada mediante investigación científi ca en bases de datos, utilizando los descriptores "anticonceptivos", "dispositivos anticonceptivos", "anticonceptivos orales" y "derrame cerebral". Se incluyeron artículos originales en los idiomas portugués, español e inglés, publicados en su totalidad y disponibles e...

Pulmonary Venous Thrombosis and Cerebrovascular Accident in a Young Oral Contraceptive User Patient: A Case Report

“…OCs are composed of synthetic hormones, such as estrogen and progesterone, which can be used isolated (progestogens) or in combination. Estrogen, notably Ethinyl estradiol, may cause important alterations in the hemostatic system, such as the 30-50% increase in the activity of procoagulant factors (factors II, VII, VIII, IX, X, XI, XII, XIII, and fibrinogen) [9], the reduction of natural anticoagulant factors (C-reactive protein, protein S, antithrombin) and the stimulation of endothelial dysfunction, which results in thromboembolic events such as DVT, PTE and CVA [1][2][3]9]. In addition to these hemostatic changes, those combined with higher doses of Ethinyl estradiol, such as the OC used by the patient, develop greater resistance to activated protein C (APC), higher levels of D-dimer, and changes in the lipid profile, such as increased LDL and total cholesterol [8,9].…”

“…In regards to CVA, 14 studies demonstrated that the use of OC increases the risk of this event, considered by the World Health Organization (WHO) a complication in primary care. Smoking, arterial hypertension, hypercholesterolemia, obesity, alcohol, migraine, and personal and family history of thrombotic diseases, are also factors implied in the increase of CVA incidence [3].…”

Social Determinants of Health and their influence on the choice of birth control methods

“…This study investigated the influence of the use of hormonal contraceptives on the occurrence of Stroke, and found that smokers who used combined oral contraceptives presented 8.57 more chances and a greater relative risk (4.9) of Stroke when compared to the chance of non-smokers (3.1) or the relative risk of those who have never used this type of method (4.2) (13) .…”

Development of a clinical protocol for detection of cervical cancer precursor lesions

“…For analysis and subsequent synthesis of the articles that met the inclusion criteria, a synoptic table was used to present data, also adapted and specially prepared for this purpose, including the following aspects: title of the research; authors’ name; intervention studied; results; recommendations; and conclusions 10 . It is noteworthy that during the elaboration of the clinical guideline, the levels of evidence and degrees of recommendation were used to classify the evidences found 11 .…”