Hormone Compound's Stroke Risk: What's The Connection?

Yes, a hormone compound can cause a stroke.

Hormone replacement therapy (HRT) is used to recover the loss of endogenous estrogen and has been suggested to improve cardiovascular health. However, studies have shown that HRT is associated with an increased risk of stroke, especially during the first year of use. This risk remains increased during and after discontinuation of HRT.

The increased risk of stroke during the first year of HRT use is possibly due to the immediate changes in hemostatic balance. The increased risk of stroke during and after discontinuation of HRT might be outweighed by its beneficial effect on the underlying progression of atherosclerosis.

The risk of stroke in women nearly doubles between age 55 and 65 years, corresponding to at least 10 years after the average age for menopause

The risk of stroke in women nearly doubles between the ages of 55 and 65, corresponding to at least 10 years after the average age for menopause. This is due to a combination of factors, including a decline in oestrogen levels, an increase in testosterone levels, and a relative androgen excess.

Oestrogen has multiple beneficial effects on the cardiovascular system, including improving vasodilation and arterial compliance by decreasing cerebral vascular tone and increasing cerebral blood flow. Conversely, androgens have a detrimental effect on cerebral blood vessels by increasing arterial tone, and they also lead to a proatherogenic profile in women by decreasing high-density lipoprotein and increasing triglycerides, low-density lipoprotein, and total cholesterol.

The decline in oestrogen levels and the increase in testosterone levels during the menopausal transition may, therefore, contribute to the increased risk of stroke in women between the ages of 55 and 65. This hypothesis is supported by studies showing that endogenous oestrogen exposure of less than 34 years is associated with an increased risk of ischemic stroke in women.

However, the relationship between age at menopause and stroke risk is complex and not yet fully understood. Some studies have found no significant relationship between age at menopause and stroke mortality or incidence, while others have suggested that the risk of stroke is increased when lifetime exposure to endogenous oestrogens is less than 34 years.

Hormone therapy, including oestrogen alone or in combination with progestin, has been shown to increase the risk of stroke in postmenopausal women. The Women's Health Initiative (WHI), a primary prevention study, found an increased risk of stroke in women aged 50 to 79 who were taking hormone therapy, regardless of the type of hormone therapy or the timing of initiation. The reason for this increased risk is not yet fully understood, but it may be related to the effects of oestrogen on accelerating atherosclerosis and increasing the risk of thrombosis.

Overall, while the decline in oestrogen levels and the increase in testosterone levels during the menopausal transition may contribute to the increased risk of stroke in women between the ages of 55 and 65, the relationship between age at menopause and stroke risk is complex and influenced by multiple factors. More research is needed to fully understand the mechanisms underlying the increased risk of stroke in this age group.

The risk of stroke is increased by 2-7 fold in women with migraine who are using hormonal contraceptives

The risk of ischemic stroke in women with migraine is increased by 2-7 fold when using combined hormonal contraceptives. The risk of ischemic stroke is increased by 2-7 fold in women with migraine with aura who are using combined hormonal contraceptives. The risk of ischemic stroke is increased by 2-7 fold in women with migraine without aura who are using combined hormonal contraceptives.

The risk of stroke is increased by 2-3 fold in women with migraine with aura who are using hormonal contraceptives

The risk of ischemic stroke is increased in women with migraine, especially migraine with aura. The use of combined hormonal contraceptives (CHCs) may further increase the risk of ischemic stroke in women with migraine, specifically migraine with aura. The absolute risk of ischemic stroke among young women who do not use CHCs is 2.5/100,000 per year whereas the same risk among young women who use CHCs is 6.3/100,000 per year. The risk of ischemic stroke is increased by 2-3 fold in women with migraine with aura who are using CHCs. The absolute risk of ischemic stroke among young women with migraine with aura who do not use CHCs is 5.9/100,000 per year whereas the same risk among young women with migraine with aura who use CHCs is 36.9/100,000 per year. The absolute risk of ischemic stroke among young women with migraine without aura who do not use CHCs is 4.0/100,000 per year whereas the same risk among young women with migraine without aura who use CHCs is 25.4/100,000 per year.

The risk of stroke is increased by 14-17 fold in women with migraine who are using hormonal contraceptives and who are also smokers

The risk of ischemic stroke is increased in women with migraine, especially migraine with aura. The use of combined hormonal contraceptives (CHCs) may further increase the risk of ischemic stroke in women with migraine. However, the quality of the current evidence is low. The available data suggests that CHCs may further increase the risk of ischemic stroke in women with migraine, specifically migraine with aura. The absolute risk of ischemic stroke among young women who do not use CHCs is 2.5/100,000 per year whereas the same risk among young women who use CHCs is 6.3/100,000 per year. Considering women with migraine with aura, the risk of ischemic stroke in those young women who do not use CHCs is 5.9/100,000 per year whereas the same risk among those young women who use CHCs is 36.9/100,000 per year. Considering women with migraine without aura, the risk of ischemic stroke in those young women who do not use CHCs is 4.0/100,000 per year whereas the same risk among those young women who use CHCs is 25.4/100,000 per year.

The risk of stroke is increased by 10-17 fold in women with migraine with aura who are using hormonal contraceptives and who are also smokers

The risk of stroke is increased in women with migraine, particularly migraine with aura. The use of hormonal contraceptives further increases this risk. The risk of stroke is highest in women with migraine with aura who are using hormonal contraceptives and who are also smokers. The risk of stroke is increased by 10-17 fold in this group of women.

Hormonal contraceptives are the most frequently used form of birth control during the reproductive years. However, migraine affects as many as 37% of women in the US. Given the significant proportion of women affected by migraine, there are several clinical considerations that arise when considering hormonal contraceptives in this population.

The American College of Obstetricians and Gynecologists (ACOG) and the World Health Organization (WHO) state that the use of combined estrogen-progesterone contraception may be considered for women with migraine headache only if they do not experience aura, do not smoke, are otherwise healthy, and are younger than age 35 years. The International Headache Society (IHS) Task Force does not state that migraine with aura is an absolute contraindication to the use of combined contraception, and suggests that decisions regarding contraceptive choice be made on a case-by-case basis based on other independent risk factors for stroke.

Frequently asked questions