Currie, J. N., & Billings, J. J. (1980). Strokes and contraceptive medication. The Medical Journal of Australia, 1(2), 58. https://doi.org/10.5694/j.1326-5377.1980.tb134624.x
Currie JN, Billings JJ. Strokes and contraceptive medication. Med J Aust. 1980;1(2):58. doi:10.5694/j.1326-5377.1980.tb134624.x
Currie, J. N., and J. J. Billings. "Strokes and contraceptive medication." The Medical Journal of Australia, vol. 1, no. 2, 1980, pp. 58.
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Three young women who smoked and took oral contraceptives had strokes
A case series from a Melbourne neurology service reports that three young women who smoked and took oral contraceptives had strokes. All three survived but were left with neurological deficits. The authors cite earlier estimates of 4.7 times the cerebrovascular death rate and 9.5 times the thrombotic stroke risk in users.
Key Findings
The women were 15, 34 and 31 years old and had taken combination oral contraceptives for six months, eight years and five years. All three were heavy smokers.
All three survived. Recovery was gradual over three months in case 1 and slow over six months in case 2; case 3 walked independently after six months. Each kept a neurological deficit.
The authors cite an estimated 4.7 times the cerebrovascular death rate in oral contraceptive users compared with non-users, and 9.5 times the risk of thrombotic stroke compared with control groups.
The authors cite an estimated excess annual death rate among ever-users of 1 per 20000 at ages 15 to 34 and 1 per 700 at ages 45 to 49.
Mortality from cerebral infarction in young women is relatively low at 9%. The authors add that a non-fatal stroke can still devastate the patient and her family.
Interpretation
The paper is a case series of three patients seen by one neurology service, with no comparison group. It calculates no rate of its own, and the cited estimates come from earlier studies. All three women smoked heavily. The authors call a joint effect of smoking and oral contraceptives on cerebral thrombosis uncertain, though several studies noted some link. They also state that lower estrogen dosage has not clearly cut the risk of heart or brain disease. The first woman's symptoms followed a heavy drinking session. The authors raise alcohol as a possible trigger and leave its link to oral contraceptives undetermined.
RRM Context
Restorative reproductive medicine looks for the cause of a cycle problem, and cycle charting uses no hormones. The pills in this series are suppressive medications that stop ovulation.
Our editorial summary of this paper, not the article's abstract.
Abstract
3 cases of stroke in young women of childbearing age are presented to show the severity of illness and mortality in women using oral contraceptives. All 3 patients smoked more than 15 cigarettes a day. The mortality rate from cerebrovascular disease in OC users has been estimated as 4.7 times that of nonusers. The risk of developing a thrombotic stroke is 9.5 times greater than a control group's. Cerebral infarction has a relatively low mortality rate in young women, 9%, but a nonfatal stroke can have a devastating effect on the patient and her family. While there were no deaths among the 3 cases, each was left with a varying degree of neurological deficit while still in the peak of a normal life span. The possibility of synergistic potentiation of OC-associated cerebral thrombosis by cigarette use is uncertain but studies have noted some correlation between the 2. It is not clear that reduction in estrogen dosage has reduced the risk of cardiac or cerebral disease. The first patient developed extreme symptoms after a heavy drinking session, thereby raising the question of alcohol as a precipitating factor.
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