Pill Users Research Articles

Impaired Glucose Tolerance-A cross Sectional Study among Middle Aged Individuals

Background and Objectives: Diabetes mellitus represents a spectrum of metabolic disorders which has become a major health challenge worldwide. Impaired glucose tolerance (IGT) forms a grey area between diabetes mellitus and normal individuals. IGT has a greater risk of developing future diabetes. To explore the prevalence of IGT in normal healthy individuals, to find correlation between IGT and BMI and family history. Materials and Methods: About 100 randomly selected subjects of middle aged group 25-45 years of both sexes were selected. Exclusion criteria include hypertension, diabetes oral contraceptives pill users, thyroid disorders, smokers and alcoholics. Oral glucose tolerance test (GTT) was done in all subjects. If 2-hour post glucose concentration was between 140- 199mg%, then the person was labelled as IGT. Variables such as Height, Weight, body mass index and family history were also taken. All the data were analyzed using chi-square, Fischer’s exact and two tailed Pearson correlation. Results: The prevalence of IGT was 16%. Age specific prevalence in subjects below 35 years was 7% and above 35 years was 9%. Interpretation and Conclusion: The prevalence of IGT was 16%. Subjects with positive family history and BMI had positive correlation with IGT. But there was no age specific prevalence between two selected groups. Key words: Diabetes mellitus, Body mass index, Impaired glucose tolerance

Effect of Combined Oral Contraceptive Pill on FVC, FEV1 and FEV1/FVC%

Background: Combined oral contraceptive pill (COCP) is the most commonly used contraceptive method in Bangladesh. This COCP may have some effects on different organs including lungs.Objective: To observe the effects of combined oral contraceptive pill (COCP) on FVC, FEV1 and FEV1/ FVC% in apparently healthy women receiving COCP.Methods: This cross sectional study was carried out in the Department of Physiology, Sir Salimullah Medical College (SSMC), Dhaka between July 2013 and June 2014. A total 30 apparently healthy young women, age ranged 20 to 30 years were included in this study who were combined oral contraceptive pill users (COCP-U) for at least 6 months. Thirty age and BMI matched combined oral contraceptive pill nonusers (COCP-NU) were taken as control. FVC, FEV1 and FEV1/FVC% of all the subjects were measured by digital spirometer. Statistical analysis was done by Independent sample ‘t’ test.Results: FVC (p<0.001), FEV1 (p<0.001) were significantly higher whereas, FEV1/FVC% (p<0.05) was significantly lower in COCP-U than those of COCP-NU. Moreover, the mean serum estrogen (p<0.001) and progesterone (p<0.05) levels were also significantly higher in COCP-U in comparison to those of COCP-NU.Conclusion: From the result of this study it can be concluded that COCP have beneficial effects on some pulmonary function parameters.Bangladesh Soc Physiol. 2015, June; 10(1): 21-25

Utilization of and Adherence to Oral Contraceptive Pills and Associated Disparities in the United States

This study investigated sociological factors that may influence women's utilization of and adherence to oral contraceptive pills. This was a retrospective cross-sectional study using the 2010-2012 Medical Expenditure Panel Survey. Female adults aged 18-50 years were included. Logistic regression was performed to discern women's decisions to use oral contraceptive pills or not. Ordinary least squares and Poisson regressions were conducted to examine the number of oral contraceptive pills received, refill frequency, and annual out-of-pocket expenditure on oral contraceptive pills. Covariates were based on the Andersen model of health care utilization. Among the study sample (weighted n = 207,007,531), 14.8% were oral contraceptive pill users. Factors positively related to oral contraceptive pill use included non-Hispanic white ethnicity, younger age, not currently married, having private insurance, residing in the Midwest, higher education level, and higher annual family income. Being non-Hispanic white and having a higher education level were positively related to oral contraceptive pill adherence. Our findings therefore demonstrate disparities in oral contraceptive pill utilization and adherence, especially according to women's race/ethnicity and educational level. This study serves as a baseline assessment for the impact of the Affordable Care Act on oral contraceptive pill utilization and adherence for future studies.

The Success of Long-Acting Reversible Contraceptives Compared With Oral Contraceptive Pills in an Adolescent Population [225

INTRODUCTION: Long-acting reversible contraceptives (LARCs) have been shown to result in increased compliance in the general population compared with oral contraceptive pills; however, little is known specifically about adolescents regarding their method preference and experiences with LARCs. The objective of the study is to identify key differences between adolescent oral contraceptive pill and LARC users to show that the use of LARCs can and should be encouraged in this population. METHODS: Adolescents using oral contraceptive pills or LARCs solely for contraception were identified with demographic information, compliance, side effects reported, and method failures measured as primary outcomes. χ2 tests were used to compare groups for each outcome of interest. RESULTS: From January 2010 to November 2011, 240 patients met inclusion criteria. A total of 129 patients (53.8%) were oral contraceptive pill users, and 111 patients (46.2%) used LARCs, including depomedroxyprogesterone acetate (n=68, 61.3%), the etonogestrel implant (n=31, 27.9%), and the levonorgestrel intrauterine device (IUD) (n=12, 10.8%). There were no statistically significant differences in demographic information, compliance rates (P=.12), or discontinuation rates (P=.19). There was, however, more side effects noted with LARCs (P<.001), most notably breakthrough bleeding (73% of LARC users; 0% of oral contraceptive pill users). However, we found that those who discontinued the levonorgestrel IUD did not cite bleeding as the reason for discontinuation. CONCLUSION: In contrast to the adult population, compliance and discontinuation rates among adolescents using either oral contraceptive pills or LARCs were comparable despite reported side effects such as breakthrough bleeding. These results should be used to encourage consideration of the use of LARCs in the adolescent population.

Contraceptive use and unintended pregnancy in Isfahan, Iran in 2012

s / Maturitas 81 (2015) 191–236 195 higher in contraceptive pills users in comparison with Levonorgestrel users. The most important cause of using emergency contraceptive methods is preventing pregnancy. In our study there was no significantly difference between two methods in occurrence of pregnancy. On the other hand, nausea and vomiting were significantly lower in levonorgestrel and it is using is easier. So, we suggest women to use it as the emergency contraceptive method if there is no contraindication. http://dx.doi.org/10.1016/j.maturitas.2015.02.277

Case report: contraceptive options and reproductive health implications for a 19-year-old female patient with a maternal history of the BRCA2 gene mutation

s / Maturitas 81 (2015) 191–236 195 higher in contraceptive pills users in comparison with Levonorgestrel users. The most important cause of using emergency contraceptive methods is preventing pregnancy. In our study there was no significantly difference between two methods in occurrence of pregnancy. On the other hand, nausea and vomiting were significantly lower in levonorgestrel and it is using is easier. So, we suggest women to use it as the emergency contraceptive method if there is no contraindication. http://dx.doi.org/10.1016/j.maturitas.2015.02.277

To pill or not to pill in GnRH-antagonist cycles: the answer is in the data already!

The planning of IVF treatment by scheduling menstruation and hence initiation of ovarian stimulation using sex-steroid pre-treatment is commonly used. Pooling data from six randomized-controlled trials encompassing 1343 patients, with and without combined oral contraceptive pill pre-treatment, suggests that the ongoing pregnancy rate per randomized woman is significantly lower in patients with oral contraceptive pill pre-treatment (relative risk [RR]: 0.80, 95% confidence interval [CI]: 0.66–0.97; rate difference [RD]: −5%, 95% CI: −10% to −1%; fixed effects model). This finding remains remarkably robust in multiple sensitivity analyses: exclusion of a study on poor responders, exclusion of the three smallest studies or exclusion of studies with a pill-free interval of less than 5 days, results in RR of 0.78 (95% CI: 0.64–0.94), 0.80 (95% CI: 0.65–0.98) and 0.79, (95% CI: 0.64–0.99), respectively. Furthermore, the finding of a significant reduction in ongoing pregnancy rate is not inconsistent with other evidence from the literature. The potential benefit of using oral contraceptive pill pre-treatment for cycle planning should therefore be balanced against its detrimental effect. Further randomized studies should test whether an effect similar to the one observed after combined oral contraceptive pill usage exists after other sex steroid pre-treatment regimens.

Associations of marital violence with different forms of contraception: Cross-sectional findings from South Asia

ObjectiveTo assess associations between marital violence and type of contraception among women in South Asia. MethodsCross-sectional analyses were conducted using marital violence data collected during the most recent Demographic and Health Surveys from Bangladesh (n=3665), India (n=56357), and Nepal (n=3037). Data were pooled to assess associations of marital violence (physical or sexual) with modern contraception use (current spacing or sterilization). ResultsSexual marital violence was associated with both modern spacing contraception (adjusted odds ratio [AOR] 1.30; 95% confidence interval [CI], 1.13–1.49) and sterilization (AOR 0.79; 95% CI, 0.70–0.88). Sexual violence was reported more often by pill users (9.8% vs 5.5% for non-users) but less often by condom users (4.5% vs 5.8% for non-users). ConclusionSexual marital violence might increase use of contraception that need not require husband involvement (pill) but decrease use of methods that require his cooperation (condom) or support for mobility, funds, or time (sterilization).

Comparison of the contraceptive use and its related factors among women seeking repeat and first-time induced abortions in iran.

Abortion in Iran, like other Islamic countries is severely restricted except in a few exceptions. However, some women who have an unwanted or mistimed pregnancy are seeking abortion. This study aimed to compare the contraceptive use and its related factors among repeat and first- time induced abortion seekers in Iran. In this cross-sectional study, 417 married women (age range, 15-49 years) seeking abortion services at either a hospital or private office in Maku City, the northwest of Iran, were selected through convenience sampling between December 2010 and March 2011. All the subjects were asked about the contraceptive methods used during the three months before the current pregnancy and the use of any emergency contraception and forced sex. Women who mentioned reasons except than completing family size for their applying for abortion were excluded from the analysis. Characteristics of women were examined using chi-square and t test. T test and Mann-Whitney U test were used to compare contraceptive methods and the regularity of contraceptive use between repeat and first-time abortion seekers, respectively. About 33.8% of the repeat abortion-seekers and 76.8% of first-time abortion seekers were using male methods (withdrawal and condom). Utilization of an intrauterine device for birth control was higher among women seeking repeat abortion than in first-time abortion seekers (P = 0.003). All of 31 pill users in the repeat abortion-seeking group missed three or more pills per month for three times during the three months before contraception. The repeat abortion seekers had used condom more regularly than those in the first-time abortion seekers. Forced sex was more prevalent in the abortion seekers who had used male method. Using male methods are prevalent in abortion-seeker women. An increased focus is needed on training the regular use of pills and using the emergency contraception for all of the couples who are first-time abortion-seekers. Moreover, information about the role of forced sex might be efficacious in decreasing illegally induced repeat abortion in couples who use condom or withdrawal methods.

Do Oral Contraceptives Alter Knee Ligament Damage with Heavy Exercise?

Hormones such as estradiol have an effect on human connective tissue, making women more susceptible to knee injuries. Indeed, women have a greater risk for non-contact injuries of anterior cruciate ligament (ACL) compared to men when participating in the same sports. The purpose of the present study was to examine the difference in ACL laxity after an eccentric exercise in the lower limbs in young healthy women between oral contraceptive pill (OCP) users and non-OCP users to see the effect of OCP on ACL laxity. Forty young healthy women participated in the experiments (25 with normal menstrual cycle and 15 with taking OCP). ACL laxity and a visual analog pain scale were measured before and after a bout of squat. OCP users had more pain than non-OCP users after heavy exercise (p < 0.001). Both groups showed a significant reduction in ACL laxity on the 2nd day after exercise (p < 0.05). While ACL laxity was always less in the OCP group, when expressed as a percent change from baseline, the ACL laxity change was similar in both groups (p > 0.05). We found that there was no statistically significant difference in ACL laxity recovery over time in response to the delayed onset muscle soreness after a bout of squat between two groups. However, health professionals working with young female adults should recognize that OCP users with less ACL laxity are at higher risk for having knee injuries because of ACL stiffness when doing exercise.

Prevalence and associated factors of contraceptive discontinuation and switching among Bangladeshi married women of reproductive age.

IntroductionContraceptive discontinuation is a worldwide incident that may be connected with low incentive to avoid pregnancy. Contraceptive discontinuation highly contributes to unplanned pregnancy and unwanted births.ObjectivesThe objective of this study was to observe the prevalence of discontinuation and switching of contraceptive methods among Bangladeshi married women. In addition, the sociodemographic factors associated with contraceptive discontinuation and switching were assessed.MethodsSecondary cross-sectional data was used in this study. A total of 16,273 married Bangladeshi women of reproductive age (15–49 years) were considered in the present study, from the Bangladesh Demographic and Health Survey, 2011. Logistic regression models were used to determine the relationships between key sociodemographic factors and user status.ResultsThe prevalence of discontinuation and switching of contraceptive method among women were 38.4% and 15.4%, respectively. The logistic regression model demonstrated that women in early reproductive years (25–29 years and 30–34 years) significantly more often (odds ratio [OR] =0.84 and 0.71, respectively) discontinued use of contraceptives. Significantly higher rates of discontinuation were pronounced among women who used the pill (OR =0.72) and injectable contraception users (OR =0.60), had small family size (OR =0.49), lived in a rural community (OR =1.65), and who were less educated (OR =1.55).ConclusionContraceptive discontinuation may reflect an association among less education, currently married, and smaller family size. Awareness of contraceptive methods can decrease the burden of unplanned pregnancies and thus progresses the family planning program.

Association of lipid markers and impaired fasting glucose: A case-control study

Contexts: Association of lipid markers and occurrence of impaired fasting glucose (IFG) have a different pattern in different populations. Aims: The present study aimed to investigate the associations of some lipid markers with impaired fasting glucose in Kermanshah city, 2013. Settings and Designs: By a case-control study, 120 IFG subjects and 240 controls were recruited. Materials and Methods: Each subject was interviewed using a sociodemographic questionnaire and lipid markers including total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-c), high-density lipoprotein cholesterol (HDL-c), and fasting plasma glucose (FPG) were checked. Statistical Analysis Used: Chi-square test (χ 2 ), independent samples t-test, Pearson correlation coefficient, and a multiple logistic regression were used for statistical analyses. Results: IFG subjects had significantly higher TC, TG, and LDL-c than controls (P 0.05). FPG was positively and significantly correlated with TG and TC ranges but not with BMI, LDL-c, and HDL-c. The highest correlation coefficients (r) with FPG was for TG rather than TC (r = 0.14, P < 0.01). In multivariable regression, the odds ratios (ORs) estimated for lipid markers were not associated with IFG but ORs in those females reported to have a history of oral contraceptive pill (OCP) usage was 2.4-fold compared to the controls [OR = 2.4, confidence interval (CI): 1.16-4.95]. Conclusions: TC, LDL-c, and TG had significantly higher values in IFG subjects and should be taken into consideration for the prevention of IFG.

Assessment of the relationship between the use of birth control pill and the characteristics of mate selection.

In recent research, scientists have begun to suspect that birth control pill use could interfere with key mechanisms that play a role when women choose a sexual partner. Many studies have shown that women, particularly during the most fertile days of their menstrual cycle, look for specific physical, psychological, and behavioral characteristics indicative of genetic quality in a short-term partner. Analysis of the psychometric properties of the Partner's Masculinity Index (PMI) scale. The scale was built to assess the degree of masculinity in hypothetical short-term partners. A total of 395 female Italian volunteers from Central Italy (M = 32.9 years old, SD = 8.58, range = 18-50 years) completed the study. The psychometric properties of PMI were then evaluated. We administered the following self-report questionnaires: (i) PMI; (ii) Minnesota Multiphasic Personality Inventory-2 Masculinity/Femininity scale; and (iii) Demographic Questionnaire. Exploratory and confirmatory factor analysis showed a four-factor structure for the PMI. Internal consistency of the measure, evaluated with the Cronbach's alpha, was satisfactory. Factorial ANOVA results showed that the group of nonpill users obtained higher scores on the PMI scale than the group of pill users (considering the fertile phase of the cycle). From an evolutionary point of view, changes in preference for indicators of genetic quality in a sexual partner are considered to be functional and adaptive. Pill use may have implications for both current and future generations. Directions for future research are discussed.

Making the Most of the Affordable Care Act's Contraceptive Coverage Mandate for Privately-Insured Women

Under the Patient Protection and Affordable Care Act of 2010 (ACA), most women of reproductive age with private health insurance have, or will soon have, first-dollar coverage of contraception and contraceptive counseling. The need for contraceptive coverage is great, because most American families want two children, resulting in the average woman spending three decades of her reproductive life trying to avoid pregnancy (Guttmacher Institute, 2012; Finer & Philbin, 2014). Contraceptive coverage without cost sharing is a sea change in women’s health insurance. This policy change has the potential to dramatically shift contraceptive use patterns, to reduce the U.S. unintended pregnancy ratedwhich stands at approximately half of all pregnancies (Finer & Zolna, 2014)dand to improve the health of women and families. In this commentary, we argue that realizing the potential of this policy change requires more action on the part of public health practitioners, insurers, health care providers, and researchers than is currently evident, andwe offer some suggestions for making the most of first-dollar contraceptive coverage.

Evaluation of cerebral venous thrombosis secondary to oral contraceptive use in adolescents.

Our goal was to evaluate the clinical patterns, additional risk factors, treatment and outcome of cerebral venous thrombosis (CVT) related to adolescent oral contraceptive pill (OCP) usage. We evaluated 22 patients with CVT related to OCPs admitted to Firat and Dicle University Hospitals from January 2008 to January 2013. We assessed the clinical features, risk factors, imaging results and prognosis. Magnetic resonance imaging (MRI) and magnetic resonance were the preferred procedures for the diagnosis of CVT. MRI revealed parenchymal lesions in 11 (50%) patients, and the remaining patients had normal MRIs. Thesinuses most frequently affected by thrombosis were the superior sagittal sinus and the transverse sinus. The additional risk factors identified for CVT were antiphospholipid syndrome, protein C deficiency, protein C and S deficiency, factor V Leiden associated with heterozygous antithrombin III deficiency, methylenetetrahydrofolate reductase and prothrombin gene mutations. CVT may be overlooked in adolescents because it is more common among middle-aged and elderly adults. CVT should be suspected in the presence of neurological symptoms in adolescents, especially in those using OCPs.

Epidemiology of hormonal contraceptives-related venous thromboembolism.

For many years, it has been well documented that combined hormonal contraceptives increase the risk of venous thromboembolism (VTE). The third-generation pill use (desogestrel or gestodene (GSD)) is associated with an increased VTE risk as compared with second-generation (levonorgestrel) pill use. Other progestins such as drospirenone or cyproterone acetate combined with ethinyl-estradiol (EE) have been investigated. Most studies have reported a significant increased VTE risk among users of these combined oral contraceptives (COCs) when compared with users of second-generation pills. Non-oral combined hormonal contraception, such as the transdermal patch and the vaginal ring, is also available. Current data support that these routes of administration are more thrombogenic than second-generation pills. These results are consistent with the biological evidence of coagulation activation. Overall, the estrogenic potency of each hormonal contraceptive depending on both EE doses and progestin molecule explains the level of thrombotic risk. Some studies have shown a similar increased VTE risk among users of COCs containing norgestimate (NGM) as compared with users of second-generation pill. However, for this combination, biological data, based on quantitative assessment of sex hormone-binding globulin or haemostasis parameters, are not in agreement with these epidemiological results. Similarly, the VTE risk associated with low doses of EE and GSD is not biologically plausible. In conclusion, newer generation formulations of hormonal contraceptives as well as non-oral hormonal contraceptives seem to be more thrombogenic than second-generation hormonal contraceptives. Further studies are needed to conclude on the combinations containing NGM or low doses of EE associated with GSD.

Strategies to improve compliance among oral contraceptive pill users: a review of the literature

Oral contraceptive pills (OCPs) remain the most commonly used reversible birth control method. Failure to adhere to daily pill taking and gaps in use are common and contribute to the risk of unintended pregnancy among OCP users. OCP compliance is influenced by a complex interplay of cognitive, behavioral, logistic, clinical, and social factors. This review outlines the evidence base for strategies that have been studied for their impact on OCP compliance.

An assessment of the quality of advice provided by patent medicine vendors to users of oral contraceptive pills in urban Nigeria.

IntroductionIn Nigeria about 50% of oral contraceptive pill users obtain their products from proprietary patent medicine vendors (PPMVs). This group of service providers are poorly trained and have very limited knowledge about contraception. This paper investigated the nature of the advice offered to simulated current and potential users of oral contraceptive pills. The main objective was to assess the nature and quality of advice provided by PPMVs to pill users.MethodThis study is based on findings from a ‘mystery client’ approach in which three scenarios related to contraceptive pill use were simulated. Each of the 12 mystery clients simulated one of the following three scenarios: new pill users (new to family planning or switching from condom to pills); user seeking a resupply of pills; and dissatisfied pill users intending to discontinue use. Simple random sampling was used to select 410 PPMVs from a total of 1,826 in four states in Nigeria. Qualitative study using in-depth interviews was also conducted.ResultsA majority of the PPMVs had pills in stock on the day of the survey and resupplied pills to the clients. PPMVs also understood the reason and importance of referring clients who were new adopters of oral contraceptive methods to a health facility; 30% of the PPMVs referred new adopters to a health facility. However, demand from clients who do not want to go to health care facilities (for various reasons) necessitated the provision of oral contraceptive pills to 41% of the first time users. Some PPMVs prescribed treatment to mystery clients who presented with perceived complications arising from the use of pills, while 49% were referred to a health facility.ConclusionThe advice given by PPMVs often falls short of safety guidelines related to the use of oral contraceptive pills. There is a need to continuously update knowledge among the PPMVs to ensure that they provide quality oral contraceptive services as PPMVs bridge the gap between medical experts and users in rural communities.

Does the Use of Electronic Interactive Social Networking Increase the Compliance Rate in Adolescent First Time Oral Contraceptive Users?

Background: Oral contraceptive pills (OCPs) are prescribed to adolescent girls for a variety of reasons and can provide relief for many gynecologic conditions and prevent unintended pregnancy. Research studies have highlighted high discontinuation rates in OCP users during the first few months. The objective of this study is to evaluate the effectiveness of an interactive social networking intervention on the compliance rate of firsttime adolescent oral contraceptive pill users. Methods: This prospective interventional study was approved by our Institutional Review Board. Patients between the ages of 13-21 presenting to our ambulatory center for gynecologic care and receiving a prescription of OCPs for the first time were offered enrollment. All participants possessed a cell phone with text messaging and photo capabilities. Nonpossession of a cell phone with texting and media capturing capabilities, previous OCP users and patients whom were actively pregnant were excluded. All eligible individuals agreed to participate. Participants received traditional verbal contraceptive counseling and chose a 21-day active pill or a three month extended cycle pill regimen. Participants chose to take their pill in the morning or in the evening. Pre and post intervention questionnaires were obtained documenting the participants perceived compliance rate. Participants were instructed to set a daily alarm on their phone to serve as a reminder and were registered for an online patient portal. A method for a three month follow up either in person, via telephone, or via the online portal was chosen. Daily text message reminders were sent Monday through Friday at either 0700 or 1645. The participants were prompted in the daily text messages to send a reply photo of their OCP pack. Although the number of participants enrolled in our study does not allow statistically significant comparison to historical controls regarding OCP compliance, several of our observational findings are reported. Results: To date, out of twenty participants, ten have completed the three month texting intervention. 51% of text messaging requests for photos of pill packs were returned. Frequency of text messaging was highest in weeks 1 and 8 (Fig, 1). Eight of the ten participants complied with a three month follow up. The rate of photo response was high in all participants who followed up after three months and low in the two patients that did not follow up. In the follow up group, patients recalled missing pills 3% of the time and all planned to continue use of an OCP. Based on photo responses, only two instances of missed pills were detected. Patients overwhelmingly preferred to follow up with text messaging in lieu of other methods. All incidences (3) of participant misuse errors were discovered via photo. All patients utilized interactive text messaging liberally for other concerns.

Are we overestimating the stroke risk related to contraceptive pills?

Hormonal contraceptives are used by million of women worldwide. Ischemic stroke is one of the major harmful effects of hormonal contraceptives, but remains a very uncommon disease before menopause. The increased risk of stroke under third and fourth-generation contraceptive pills and nonoral contraceptives has been recently highlighted. Given the benefits associated with combined hormonal contraceptives (COCs), it is important to properly evaluate their risks in order to provide a better benefit/risk balance to young women. Scarce studies addressing the rates of stroke in young women suggest that the fraction attributable to the contraceptive pill remains low. In contrast, there is abundant literature on the relative risks of stroke under COCs. The risk of arterial disease seems to be similar among users of second and third-generation pills, drospirenone-containing pills and nonoral hormonal contraceptives. Progestin-only contraceptives do not appear to be associated with an increased risk of stroke. New formulations of hormonal contraceptives are not safer than second-generation COCs. Even if the absolute numbers of strokes attributable to hormonal contraceptives is very low, stringent selection of patients should help to reduce the events still more, and progestin-only contraceptives/nonhormonal methods should be preferred in cases of associated risk factors.