#None #Cryptogenic Stroke #ESOC 2025 #Combined Oral Contraceptives

Increased Cryptogenic Stroke Risk Linked to Combined Oral Contraceptives in Young Women

In a groundbreaking study shared at the European Stroke Organisation Conference (ESOC) 2025, researchers unveiled alarming statistics regarding the health risks linked to combined oral contraceptives (COCs) among young women. The investigation highlighted that young women utilizing these contraceptives face a threefold increase in the risk of cryptogenic ischemic stroke (CIS), which accounts for a significant proportion of strokes in this demographic.

Cryptogenic Stroke: A Growing Concern

Cryptogenic ischemic stroke, defined as a stroke with no identifiable cause, is particularly prevalent among adults under 50. Research indicates that up to 40% of all ischemic strokes in younger adults are cryptogenic, presenting considerable diagnostic challenges and underscoring the importance of evaluating sex-specific risk factors, such as hormonal contraceptive use. While previous studies have drawn links between oral contraceptives and stroke incidence, this latest research underscores the specific correlation of COCs with cryptogenic strokes in young women—a subject that has been largely overlooked in the medical community.

Methodology of the Study

The study, known as Searching for Explanations for Cryptogenic Stroke in the Young (SECRETO), involved a comprehensive analysis of 268 young women between the ages of 18 and 49, all diagnosed with CIS. These participants were matched with 268 control subjects of similar age without a history of stroke across 14 European medical centers. Among the women participating, 66 reported using COCs, while 38 controls accessed similar contraceptive methods.

After adjusting for variables like age and established comorbidities (e.g., hypertension, obesity, and migraines), the researchers established an adjusted odds ratio of 3.00 (95% CI 1.61-5.57) for the association between COC use and the risk of CIS. Notably, the researchers found no significant interactions between COC usage and common risk factors, suggesting that the increased risk may be independent of other established contributing factors.

Expert Insights

Dr. Mine Sezgin, a neurologist from Istanbul University and the principal investigator of the study, commented, "Our findings corroborate previous evidence linking oral contraceptives with stroke risk, but what sets this apart is the persistence of this association even when accounting for other known risk factors. This strongly indicates possible additional mechanisms at play, potentially of a genetic or biological nature."

Most of the COC users in the study were taking ethinyl estradiol-based formulations, averaging 20 micrograms in dosage. Different forms of estrogen were also documented, including hemihydrate estradiol and estradiol valerate. "We calculated the estrogen equivalent dose for each participant to maintain consistency," explained Dr. Sezgin.

Future Research Directions

Despite these crucial findings, the study researchers emphasized the necessity for broader studies to identify if certain formulations of oral contraceptives carry different levels of risk. This understanding could be instrumental in guiding personalized contraceptive choices for women. In light of the findings, medical professionals are urged to exercise caution when prescribing combined oral contraceptives to women with known vascular risk factors or a history of ischemic stroke.

"Our results serve as a call to action for a detailed assessment of stroke risk in young women, especially those with additional risk factors," Dr. Sezgin concluded.

Future research aims to delve into the biological and genetic mechanisms that could account for the observed heightened risk associated with COCs, enhancing the current understanding of how hormonal contraceptives might elevate this risk independently.

Final Notes

The study, presented at ESOC 2025, is a critical contribution to the ongoing dialogue regarding women's health and the implications of contraceptive use. For healthcare providers, it emphasizes the importance of personalized medical advice tailored to the individual risk profiles of women considering hormonal contraceptives.