Новое исследование не выявило статистически значимого роста риска инсульта у женщин с мигренью при приеме комбинированных оральных контрацептивов

Oral contraceptives combining estrogen and progestogen are not associated with a statistically significant increase in stroke risk compared with progestogen-only pills among female individuals with migraine with aura. These findings were published in Obstetrics & Gynecology. Combined oral contraceptives (COCs) are contraindicated in individuals with migraine with aura because of the elevated stroke risk associated with these contraceptives and this type of migraine. However, that contraindication is largely supported by older studies of higher-dose formulations, including those containing 50 micrograms or more of ethinyl estradiol, than those commonly prescribed today. To evaluate the risk associated with modern contraceptive formulations, researchers conducted a retrospective cohort study using primary care medical records from the UK and linked hospital data from the Clinical Practice Research Datalink Aurum. The analysis included female individuals aged 15 to 49 years with migraine with aura who initiated a COC or progestogen-only pill (POP) between 2000 and 2024. The participants had no history of stroke, other thrombotic disease, hypercoagulability, menopause, or perimenopause and had not used another estrogen-containing medication during the previous year. A total of 12,429 individuals initiated COCs and 41,984 initiated POPs. Those prescribed COCs were younger than those prescribed POPs, with median ages of 24 and 27 years, respectively. [T]hese data provide reassurance that the risk of stroke in this patient population is not greatly increased by the use of COCs. Among COC users, 71.4% were prescribed formulations containing 30 micrograms of ethinyl estradiol, followed by 35 micrograms (16.7%), 20 micrograms (9.7%), and more than 35 micrograms (1.9%). A total of 24 individuals (0.2%) received COCs containing other types of estrogen. In the primary as-treated analysis, 6 individuals experienced ischemic stroke during 1 year of follow-up: 2 in the COC group and 4 in the POP group. The 1-year risk for ischemic stroke was 17.36 per 100,000 people among COC users and 17.62 per 100,000 people among POP users. After adjustment for treatment and censoring, the difference between the groups was not statistically significant. The 1-year risk difference for ischemic stroke between the COC and POP groups was 9.53 per 100,000 people (95% CI, -38.65 to 57.71), and the adjusted risk ratio (RR) was 1.47 (95% CI, 0.24-8.90). The researchers also found no statistically significant difference between the groups for any stroke. The 1-year risk difference for any stroke was 3.49 per 100,000 people (95% CI, -45.17 to 52.16), and the adjusted RR was 1.13 (95% CI, 0.21-6.13). When the researchers examined shorter follow-up periods, the estimated differences between groups were larger, but the estimates remained statistically uncertain. At 3 months, the adjusted risk difference for ischemic stroke was 17.62 per 100,000 people (95% CI, -21.07 to 56.30), with an adjusted RR of 9.73 (95% CI, 0.61-155.47). The authors noted that all estimates had wide confidence intervals that encompassed both harmful and protective effects. Study limitations included potential confounding by indication because individuals at higher risk for stroke may have been preferentially prescribed POPs; the inability to evaluate subgroups because of the small number of stroke events; residual confounding; incomplete information on migraine frequency; potential underdiagnosis or inconsistent recording of migraine with aura; and limited generalizability to other populations. The study population was predominantly White, and the authors noted that potential differences in stroke risk by race or ethnicity were not well captured. “Additional research into the safety of modern-day contraceptives among individuals with migraine with aura should improve the precision of these clinically relevant comparisons to better support patient and clinician decision-making,” the study authors concluded. They continued, “However, these data provide reassurance that the risk of stroke in this patient population is not greatly increased by the use of COCs.” References: Gibbs LR, Fox MP, Aparicio HJ, Jick S. Combined oral contraceptives and stroke risk in individuals with migraine with aura. Obstet Gynecol. Published online August 1, 2026. doi:10.1097/AOG.0000000000006306