Hormonal contraception and the risk of heart attack and stroke

A new study was published in the British Medical Journal in February 2025 showing that all hormonal contraceptives apart from the hormonal coil increase the risk of heart attacks and strokes in those who take them. But what does this mean in reality? Should we all be panicking?

Don’t worry, our Medical Director Dr Mel is here to explain all……

What does this study tell us about the risk of heart attack and stroke?

This extensive research, involving over two million Danish women aged 15 to 49, offers important information about cardiovascular health and the impact of hormonal contraception. The study indicates that certain hormonal contraceptives are associated with a slight increase in the risk of ischaemic stroke (caused by a blood clot in the arteries supplying the brain) and heart attack (caused by a blood clot in the arteries supplying the muscle of the heart). Existing studies suggested an increased risk of these events with hormonal contraception use, but findings have been inconsistent and from outdated studies and evidence on the effects of mode of administration, oestrogen type, progestogen type, and duration of use was lacking.

This study shows that combined contraceptives (containing both oestrogen and progestogen), such as the pill, were linked to a twofold increase in these risks. Non-oral combined methods, like the vaginal ring and patch, were associated with even higher relative risks. For instance, the vaginal ring was linked to a 2.4-fold increase in stroke risk and a 3.8-fold increase in heart attack risk.

In contrast, progestogen-only contraceptives – including the progestogen-only pill (mini pill), contraceptive injection, implant, and hormonal coil (also known as the intrauterine system (IUS) or hormonal intrauterine device (IUD)) – showed little to no increased risk, although this was based on limited data. The hormonal IUD (coil) in particular was not associated with any increased risk.

How worried should I be if I use these contraceptives?

In light of these findings, it’s important to recognise that while the relative increase in risk is notable, the absolute risk or overall likelihood of experiencing a heart attack or stroke due to hormonal contraceptive use remains low. This is because the baseline risks of ischaemic stroke and heart attack among women of reproductive age is already very low. For example, using the combined pill translates to one additional ischaemic stroke per 4,760 women per year and one additional heart attack per 10,000 women per year.

Moreover, pregnancy and the postpartum period inherently carry higher risks of cardiovascular events than those associated with the use of hormonal contraceptives. Therefore, women should not be alarmed but are encouraged to discuss their individual risk factors and contraceptive options with their healthcare professional to make an informed choice.

Is this fair that the burden of an increased risk is always on women?

It feels like there is always some study being published to terrify us about our contraceptive choices – and at The Lowdown we guess you can see that as a good or bad thing. Good in that people are still investing time and money into research into contraceptive methods that have been around for decades. Bad, in that we’re still understanding how these drugs impact us. It’s not fair that the burden is on women, and at The Lowdown we have consistently called for better investment into new methods to prevent pregnancy, that are for men and women.

Who is most at risk? 

Women with existing cardiovascular risk factors – such as high blood pressure, obesity, smoking, a history of blood clots, migraines with aura, or a family history of stroke or heart disease – may face a higher absolute risk when using combined hormonal contraceptives.

For these individuals, non-oestrogen-containing methods or non-hormonal methods may be considered more suitable. Women should not panic or abruptly stop their contraception, but rather discuss their individual risk factors with their healthcare professional and explore alternative methods if needed. We have a whole article dedicated to explaining these risks and supporting your choices.

What other safe contraceptives are there for women to choose?

You can take a look at the best rated contraceptives at The Lowdown from our community here, and using our contraception recommender tool is a great place to start.

The only long acting non-hormonal contraceptive on the market is the copper coil (IUD) which is a small, T-shaped device made of plastic and copper that is inserted into your womb by a doctor or nurse. It is a very popular non-hormonal method for The Lowdown community as it’s very effective and lasts between 5 to 10 years. Like all methods, it comes with risks like a small increase of infection or perforation of the uterus. Read more here.

It’s important to remember that the risks of hormonal contraceptives are small, and hormonal contraception has multiple other benefits, not only as a highly effective way to prevent pregnancy, but also to treat reproductive health conditions like heavy or painful periods, endometriosis, PCOS and PMS. Your choice is an individual one and we celebrate that – so do whatever feels right for you with support from your healthcare professional.