Warning of stroke risk due to abuse of birth control pills

The Stroke Department, Institute of Neurology, 108 Central Military Hospital has just received and successfully treated two young female patients with stroke due to cerebral venous sinus thrombosis (CVT) - a dangerous but easily overlooked disease, especially in women of reproductive age and those using oral contraceptives for a long time.

Female patient, of childbearing age, admitted to hospital in critical condition: Patient started with headache for several days, pain reliever helped a little, still had normal activities.

Before admission, the patient had a severe headache. When admitted, he was in a state of impaired consciousness, with continuous generalized convulsions, deep coma, quadriplegia, and dilated pupils.

After brain CT scan and cerebral angiography, the patient was diagnosed with a large cerebral hemorrhage with bilateral parietal lobe transformation due to superior sagittal sinus thrombosis and sinus junction. D-Dimer test increased to more than 5000 ng/mL.

The patient was immediately consulted by a multidisciplinary team between the Stroke Department (A7C), Neurointerventional Neurology Department (A7E), Neurosurgery Department (A7B), and multimodal treatment. The patient was prescribed endotracheal intubation, active mechanical ventilation, anti-cerebral edema, and unfractionated Heparin anticoagulant. After that, the doctors coordinated a decompressive craniectomy due to cerebral edema threatening herniation, and maintained postoperative low molecular weight Heparin (LMWH).

After intensive treatment, the patient was alert, able to wean off the ventilator, able to communicate and partially active – a positive result in a complex case.

The patient was treated intensively.

Another young female patient, also of reproductive age, was admitted to the hospital because of: Persistent headache, progressive weakness in the left side of the body, difficulty walking for several days. The patient was admitted to the hospital in a conscious state, weakness in the left side of the body, muscle strength 3/5, after CT scan and screening tests, the diagnosis was: Right temporal cerebral infarction due to thrombosis of the straight sinus, sigmoid sinus and left transverse sinus.

The patient was admitted to the hospital without complications of severe cerebral edema or herniation. The patient was treated medically with anticoagulants according to the protocol and recovered well, and was discharged with the ability to live independently.

According to Master, Doctor Nguyen Hai Linh, Department of Cerebral Stroke, both patients above were using daily birth control pills for a long time.

Dr. Linh said that daily oral contraceptives usually contain the hormones estrogen and progesterone, which work by: Inhibiting ovulation; thickening cervical mucus, preventing sperm from reaching the egg; changing the endometrium, preventing the egg from implanting.

This is an effective and convenient method, however, long-term abuse can cause serious side effects, especially increasing the risk of thrombosis (blood clots).

According to statistics, the rate of venous thromboembolism (VTE) in women using OCPs is 3-6 times higher than that of non-users, according to global statistics. Cerebral venous sinus thrombosis can cause complications of cerebral hemorrhage or cerebral infarction or a combination of hemorrhage and cerebral infarction.

In Vietnam, according to a study by Tu Du Hospital and the Central Obstetrics Institute (2021), nearly 50% of women of childbearing age have used birth control pills, of which nearly 20% have used them continuously for more than 12 months without regular check-ups.

The risk is higher in women with: Smoking; overweight/obesity; family history of stroke/thrombotic events; hypercoagulable disorders (Protein C/S deficiency, antiphospholipid syndrome…).

Therefore, Master, Doctor Nguyen Hai Linh recommends that if you intend to use monthly birth control pills for a long time, women should see a specialist for examination, necessary tests and advice on how to use the drug safely and effectively. Do not use or prolong the time of taking the drug without professional instructions.

Besides birth control pills, you can consider methods such as: intrauterine device (IUD), contraceptive implant, contraceptive patch, sterilization (for those who no longer want to have children), condom (simple, non-hormonal, dual protection method).

In particular, go to a reputable medical facility to get advice from a doctor on the method most suitable for your physical condition and health.

Source: https://nhandan.vn/canh-bao-nguy-co-dot-quy-do-lam-dung-thuoc-tranh-thai-post871719.html