Many hormonal birth control methods have a slightly increased risk of stroke. Your risk for stroke depends on various factors, and there are steps you can take to reduce your risk.

The overall risk of stroke related to birth control use — namely oral contraceptives — is relatively low.

Birth control pills are the most commonly prescribed contraceptive in the United States. Combination pills, also known as combined oral contraceptives, are the most commonly prescribed form.

According to the American College of Cardiology, the risk of stroke related to combination birth control pills is lower than the risk of stroke related to pregnancy.

The risk increases a bit more if you smoke, have hypertension, or have a migraine with aura, says Sophia Yen, MD, co-founder and CEO of Pandia Health, an online birth control provider.

“Estrogen-containing birth control increases your risk of a stroke more than progestin-only birth control options,” says Yen.

Three types of hormonal birth control contain estrogen:

How long you use the method may also play a role.

Researchers in a 2019 meta-analysis of oral contraceptive use observed a ~20% increase in the risk of ischemic stroke and total stroke for every 10 micrograms of estrogen or a 5-year increment of use.

That said, “Much of the research on the topic does not take into consideration the lower dose of estrogen-containing pills that are often prescribed today,” says Lindsay Sarrel, a nurse practitioner with Manhattan Cardiology in New York.

More research is needed to better understand the potential relationship between today’s formulations and risk of stroke.

There are a many factors that can increase your risk of stroke.

Some are outside of your control, like your:

  • age
  • sex
  • genetics
  • family history of stroke
  • proximity to air pollution

Other health conditions can increase your risk, including:

  • anxiety
  • atherosclerosis
  • atrial fibrillation
  • depression
  • diabetes
  • heart disease
  • heart valve disease
  • high blood pressure
  • high cholesterol
  • kidney disease
  • lupus
  • migraine
  • obesity
  • rheumatoid arthritis
  • sleep apnea

You may be able to change or improve some risk factors, such as:

  • poor nutrition
  • physical inactivity
  • tobacco use

If you’re currently using an estrogen-containing contraceptive, you might consider switching to a method with a lower dose of estrogen, suggests Yen.

She says it may be worthwhile to avoid pills with more than 35 micrograms of estrogen.

You might also avoid the contraceptive patch, which has been shown to cause higher estrogen levels in the blood than other options, Yen adds.

Birth control method aside, you can also decrease your risk of stroke by exercising regularly, eating a diet low in sugar and saturated fat, and staying hydrated, says Sarrel.

Progestin-only birth control methods aren’t associated with an increased risk of stroke. This includes:

  • hormonal IUD
  • implant
  • minipill
  • shot

Depending on your individual needs, you might choose to forgo hormones entirely. There are several nonhormonal contraceptives, says Sarrel, including:

“Hormonal birth control, particularly estrogen-containing pills, can carry an increased stroke risk,” says Sarrel.

As such, if you have other risk factors for stroke, it’s important to have a conversation with a clinician to identify the best birth control option for you.

Gabrielle Kassel (she/her) is a queer sex educator and wellness journalist who is committed to helping people feel the best they can in their bodies. In addition to Healthline, her work has appeared in publications such as Shape, Cosmopolitan, Well+Good, Health, Self, Women’s Health, Greatist, and more! In her free time, Gabrielle can be found coaching CrossFit, reviewing pleasure products, hiking with her border collie, or recording episodes of the podcast she co-hosts called Bad In Bed. Follow her on Instagram @Gabriellekassel.