Stroke in Women - Oral Contraception, Pregnancy, and Hormone Replacement Therapy

Abstract

Stroke is a devastating disease affecting millions of people worldwide every year. Female stroke victims have higher mortality rates and they do not re-cover as well as men. Women's longevity and different vascular risk factor burden like a larger prevalence of atrial fibrillation play a role. Women also have unique risk factors such as oral contraception, pregnancy, estrogen decrease after the menopause and hormone replacement therapy, which should all be evaluated and taken into consideration in treatment decisions both in the acute phase of stroke and in secondary prevention. In this review, the evidence regarding these hormonal aspects and the risk of stroke in women are evaluated. The relevant guidelines are studied and research gaps identified. Future topics for research are recommended and current treatment possibilities and their risks discussed.

Stroke and Multi-Organic Infarction Revealing Peri-Partum Cardiomyopathy, an Unusual Presentation: About a Case

“…A review of maternal strokes at a stroke referral center in New York found that more than 70% of strokes occurred after childbirth [8].…”

Contraception and family planning at the extreme of reproductive life – climacteric

“…7 While endogenous estrogen protects younger women, administration of estrogen in the form of contraceptive pills doubles the risk of stroke, in addition to increasing risks associated with advancing age, smoking, hypertension, obesity and migraine with aura. 8 Greater concern is addressed to thromboembolic events, both arterial and venous, with increased incidence in climacteric women. The lowest possible dose of ethinyl estradiol or estradiol associated with progestins yielding lower thromboembolic risk, such as levonorgestrel and norethindrone, are recommended.…”