Modern hormonal contraception did not raise major event risk
In Finnish women aged 15–49, modern systemic hormonal contraception was not linked to higher rates of heart attack or ischemic stroke.
*Prospective nationwide cohort with nested case-control; Level 2b (OCEBM).

Citation

Edrees E, Gyllenberg F, Putaala J, Haukka J, Heikinheimo O. Hormonal contraception and risk of major adverse cardiovascular events: A nationwide registry study from Finland. Contraception. 2026;156:111311. doi:10.1016/j.contraception.2025.111311

Background

Earlier studies suggested some hormonal contraceptives may increase blood-clot–related heart and brain events. Because formulations and prescribing practices have changed, updated safety data are needed.

Patients

Women aged 15–49 living in Finland (n=584,236). Excluded: prior heart attack or stroke before follow-up, and several prior cancers.

Intervention

Current use of systemic hormonal contraception, including combined pills containing ethinyl estradiol or estradiol, and progestin-only pills.

Control

Non-use (no redeemed prescription for any hormonal contraception in the prior 360 days).

Outcome

Major adverse cardiovascular events: first hospitalization for heart attack or ischemic stroke.

Follow-up Period

Up to 2 years (2018–2019).

Results

Outcome Cases Incidence per 100,000 person-years
Major adverse cardiovascular events 334 28.6
Heart attack 84 7.2
Ischemic stroke 250 21.4

After adjustment, risk estimates (odds ratios) for major adverse cardiovascular events were not significantly different for combined pills with ethinyl estradiol, combined pills with estradiol, or progestin-only pills versus non-use.

Limitations

Short follow-up and relatively few events limit precision. Smoking and body weight were not available, leaving possible unmeasured differences between users and non-users. Some long-acting methods were not captured in prescription data, and prescription fills do not guarantee actual use.

Funding

Jane and Aatos Erkko Foundation; Primary Care Research Foundation; Helsinki University Hospital.

Clinical Application

Reassure most reproductive-age patients that modern systemic hormonal contraception did not show higher heart attack or ischemic stroke risk when used according to guidelines.