Studies of the relationship between oral contraceptives and stroke have been debated for decades, and these studies have yielded conflicting results. According to a review of studies by three neurologists, oral contraceptives nearly double the risk of stroke.

There are about 4.4 ischemic strokes for every 100,000 women of childbearing age. Birth control pills increase the risk 1.9 times, to 8.5 strokes per 100,000 women, according to a well-performed "meta-analysis" cited in the article. This is still a small risk; there's one additional stroke for every 25,000 women who take birth control pills, according to the article.

For women who take birth control pills and also smoke, have high blood pressure or have a history of migraine headaches, the stroke risk is significantly higher.

"When prescribing oral contraceptives, doctors should balance the risks and benefits for each individual patient," said senior author Dr. Jose Biller. "For a healthy young woman without any other stroke risk factors, the benefits of birth control pills probably outweigh the risks. But if a woman has other stroke risk factors, she should be discouraged from using oral contraceptives."

The authors describe a 30-year-old woman who experienced a stroke when she was only 30 years old. She had suffered migraine headaches since she was 15 years old, which further increased her stroke risk.

Another 27-year-old woman suffered severe right-sided headaches, nausea, vomiting and unsteadiness while on oral contraceptives. She stopped taking birth control pills and was treated with a blood thinner for six months. On a follow up visit, she was doing well except for occasional headaches.

"These observations obviously need to be considered in the proper context of a careful understanding of possible risks and benefits associated with the use of oral contraceptives, as well as those associated with other forms of contraception," Biller said.

How oral contraceptives might cause strokes is not completely understood. But two possible mechanisms are the increased risks of blood clots and high blood pressure associated with oral contraceptives.

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References:
1. J. Biller, et al. MedLink Neurology.

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