Heart health risks of oral contraceptives: Watch out for hypertension, stroke and more

For women over 35 who smoke, the risk is especially elevated. Many healthcare providers strongly advise against prescribing COCs to women in this group due to their significantly higher risk of blood clots. In such cases, alternative forms of contraception, such as progestin-only pills or non-hormonal methods, may be more appropriate.

Hypertension

Oral contraceptives can also contribute to elevated blood pressure, a condition known as hypertension. This poses additional risks for women who already have high blood pressure, as it can increase the likelihood of cardiovascular diseases such as heart attack or stroke. The use of COCs may exacerbate hypertension, making it critical for women with a history of high blood pressure to avoid these forms of contraception.

Women with normal blood pressure can still experience an increase in blood pressure while taking oral contraceptives. Regular monitoring of blood pressure is essential for all women on COCs, especially those with a family history of hypertension or other cardiovascular conditions.

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Heart attack and stroke

The combined effects of increased blood pressure, changes in blood lipid profiles, and the higher risk of blood clotting significantly raise the potential for heart attack and stroke in women using contraceptive pills. While the absolute risk for younger, healthy women remains relatively low, it becomes more concerning in older women or those with additional cardiovascular risk factors.

Women over the age of 35, especially those who smoke, have diabetes, or have a family history of heart disease, are at higher risk. For these women, healthcare providers often recommend non-hormonal forms of contraception or lower-risk options like progestin-only pills to minimise the chances of a heart attack or stroke.

Progestin-only pills

Progestin-only pills, often referred to as the "mini-pill," are considered a safer alternative to COCs in terms of cardiovascular risks. These pills do not contain oestrogen, which is the main culprit in increasing the risk of blood clots, hypertension, and stroke. For women with a history of cardiovascular issues or those who are at a higher risk of developing such conditions, progestin-only pills or non-hormonal contraceptive methods may be the best option.

Women who are concerned about the cardiovascular risks associated with COCs should discuss their options with a healthcare provider. In some cases, switching to a progestin-only pill can significantly reduce the risk of cardiovascular complications without compromising contraceptive effectiveness.

Preventive strategies

Before prescribing any form of oral contraceptive, healthcare providers typically conduct a thorough risk assessment. Factors such as age, smoking status, family history, and pre-existing health conditions are carefully considered to determine the safest and most effective form of contraception. For women at higher risk of cardiovascular disease but still needing reliable contraception, options like progestin-only pills, intrauterine devices (IUDs), or barrier methods are often recommended.

Regular monitoring of blood pressure, cholesterol levels, and other health metrics is essential for women using COCs. This becomes particularly important as women age or if they have lifestyle factors that elevate their risk of cardiovascular disease, such as smoking or a sedentary lifestyle.