Archives of Gynecology and Obstetrics

, Volume 297, Issue 5, pp 1181–1191 | Cite as

Association between oral contraceptives and risk of hemorrhagic stroke: a meta-analysis of observational studies

  • Zhenlin Xu
  • Yuanping Yue
  • Jianling Bai
  • Chong Shen
  • Jingjing Yang
  • Xiaoping Huang
  • Yang Zhao
  • Ying Li
General Gynecology



To estimate the risk of hemorrhagic stroke associated with current use of oral contraceptives (OCs), and to further depict how the risk was affected by study characteristics.


We searched PubMed, Embase, and Cochrane Library for relevant articles published up to February 2017 that examined the association between OC use and risk of hemorrhagic stroke. Two investigators independently reviewed articles based on inclusion criteria. The Newcastle–Ottawa scale was employed to evaluate quality of studies. Random-effects meta-analysis model was used to generate summary risk estimates.


Fifteen independent studies (5 cohort studies and 10 case–control studies) with 4271 hemorrhagic stroke cases were included in this meta-analysis. The overall summary odds ratio (OR) for hemorrhagic stroke (HS) in relation to current OC use was 1.39 [95% confidence interval (CI), 1.05–1.83]. Subgroup analyses on hemorrhagic stroke types showed that OC use was associated with subarachnoid hemorrhage (SAH) (OR 1.68; 95% CI 1.21–2.12), but not with intracerebral hemorrhage (ICH) (OR 0.92; 95% CI 0.33–2.54). The risk of hemorrhagic stroke was increased slightly among current OC users with high-dose estrogen (OR 1.60; 95% CI 1.12–2.27). The risk of hemorrhagic stroke was further increased in OC users with additional risk factors including current smoking, hypertension, and history of migraine.


This meta-analysis of observational studies suggests that current use of OCs could contribute to a small increased risk of hemorrhagic stroke, and the increased risk is related to subarachnoid hemorrhage, but not intracerebral hemorrhage.


Oral contraceptive Hemorrhagic stroke Pharmacoepidemiology Meta-analysis 



This study was funded by the National Natural Science Foundation of China (Project No. 81573227, 81573232 and 81373102) and the Ministry of Science and Technology of China (National Key Project No. 2006BAI15B07). This study was also funded by Top-notch Academic Programs Project of Jiangsu Higher Education Institutions (TAPP: PPZY2015A067), and the Qing-lan Project of Jiangsu Province and the Priority Academic Program Development of Jiangsu Higher Education Institution (PAPD).

Author contribution

ZX and YY: Project development, data collection, manuscript writing/editing. JB and YZ: Project development, data analysis, manuscript editing. CS, JY and XH: Project development. YL: Project development, manuscript editing.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Epidemiology, School of Public HealthNanjing Medical UniversityNanjingChina
  2. 2.Department of Biostatistics, School of Public HealthNanjing Medical UniversityNanjingChina
  3. 3.Hohai University HospitalHohai UniversityNanjingChina
  4. 4.Pukou Center for Disease Control and Prevention of Nanjing CityNanjingChina

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