Contraceptive Pearl: Oral Contraceptives and Risk of Cardiovascular Disease

Which oral contraceptive pills (OCPs) are best for patients at risk for cardiovascular disease?

Estrogen raises the risk of ischemia. Several reviews of studies in the US and Canada conclude that the risk of myocardial infarction and ischemic stroke increases from 5 per 100,000 to 8 per 100,000 women of reproductive age who take estrogen-containing OCPs. Although the absolute risk is small, the CDC gives estrogen-containing contraceptives a “4” rating (absolute contraindication) for anyone with coronary heart disease, stroke, or multiple cardiovascular risk factors. Progestin-only pills, implant and IUDs get a more favorable “2” rating for the same group of patients, while progestin injection gets a “3” rating.

Which is the most heart-healthy OCP for patients whose cardiovascular risk profile is normal? A 2015 Cochrane review found little difference in arterial thrombosis risk associated with progestin type. However, higher estrogen dose correlated with higher risk of cardiovascular events. Levonorgestrel may confer a lower risk of venous thrombosis than other progestins. From a cardiovascular standpoint, pills containing levonorgestrel and 30 mcg or less of estrogen may be safest — and all progestin-only methods are significantly safer.


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Roach REJ, Helmerhorst FM, Lijfering WM, Stijnen T, Algra A, Dekkers OM.The risk of heart attack and stroke in women using birth control pills. Cochrane Database of Systematic Reviews. 2015; 8: CD011054.

De Bastos M, Stegeman BH, Rosendaal FR, et al. Combined oral contraceptives: venous thrombosis. Cochrane Database of Systematic Reviews. 2014; 3: CD010813.

Rotermann M, Dunn S, Black A. Oral contraceptive use among women aged 15 to 49: results from the Canadian health measures survey. Statistics Canada. 2015; 26(10): 82-003-x.


The Reproductive Health Access Project does not accept funding from pharmaceutical companies. We do not promote specific brands of medication or contraception. The information in the Contraceptive Pearls is unbiased, based on science alone.

Contraceptive Pearls

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