Women using combined oral contraceptives, commonly known as the birth control pill, face a tripled risk of stroke, affecting roughly six in 100,000 young women annually. However, the absolute danger remains small, according to findings from a 14-country European study.
The research, presented at the European Stroke Organization Conference (ESOC) 2025, analyzed data from more than 500 women across 14 European medical centers.
Researchers found that women between 18 and 49 years who used combined oral contraceptives had triple the odds of experiencing cryptogenic ischemic stroke, a type of stroke with no identifiable cause, compared to women who did not use the pills.
One Hormone in Pill Especially Linked to Risk
The study, called the SECRETO project, involved 268 women who had experienced cryptogenic stroke and 268 women without any stroke history.
After adjusting for factors such as age, high blood pressure, smoking, migraines with aura, and belly fat, the researchers still observed increased risk.
Furthermore, the data regarding the safety of 20 micrograms of ethinylestradiol versus 25, 30, or 35 micrograms suggest less risk with 20 microgram formulas.
The findings come as stroke rates among younger adults have increased since the 1980s, despite an overall decline in stroke cases across high-income countries. Cryptogenic strokes represent 30 to 50 percent of all ischemic strokes among young adults, according to Dr. Achillefs Ntranos, founder of Achilles Neurology Clinic, who was not involved in the research.
“Strokes in younger adults, ages 18 to 49, have actually risen since the 1980s, now making up about 10 to 15 percent of all strokes in the U.S.,” Ntranos told The Epoch Times.
Research suggests this is because estrogen, at certain doses, can promote blood clotting and potentially elevate blood pressure.
Clinical Implications and Alternatives
The researchers advise health care providers to be cautious when prescribing combined oral contraceptives to women who have other risk factors for blood vessel problems or previous strokes. “Our findings should prompt more careful evaluation of stroke risk in young women, particularly those with additional risk factors,” Sezgin stated.
For women concerned about the risk, Elkattah advises considering non-estrogen contraceptive methods, such as progestin-only pills (mini-pills), hormonal IUDs, copper IUDs, and implants or injections such as Depo-Provera.
Balancing Risks and Benefits
Medical experts caution against discontinuing contraceptive use based solely on these findings.
“For most young, healthy, non-smoking women who don’t experience migraines with aura or have other significant vascular risk factors,” Ntranos said. “Combined oral contraceptives remain generally safe and highly effective.”
However, he added, the findings “underline the necessity of a personalized approach rather than a one-size-fits-all policy.”
The research adds to ongoing discussions about contraceptive safety.
The current study suggests that even reduced-dose pills may carry some risk.
Sezgin stated that while the findings offer important initial insights, larger studies are needed to determine if certain pill types carry different risks—information that could help doctors tailor contraceptive choices more safely for women.
Moving forward, Sezgin and team plan to explore potential biological and genetic reasons to explain the observed link between birth control pills and increased stroke risk to understand how these medications might elevate risk.
