Oral contraceptives, menopause hormone replacement therapy, and risk of stroke

Objectives: To review available evidence from observational and intervention studies on oral contraceptives (OC), menopause hormone replacement therapy (HRT) and stroke. Methods: Qualitative literature review. Results: High dose OC were associated to elevated risk of stroke. However, the use of low oestrogen OC preparations by non-hypertensive women not at high baseline risk is not related to an appreciable risk of stroke. With reference to HRT, randomised clinical trials showed an excess risk of stroke among users of combined therapy. Conclusions: In non-hypertensive women below age 35 stroke is not materially related to the use of low dose OC. HRT is associated to a moderate excess risk in randomised studies, and should therefore not be used for the prevention of stroke