The stroke may be venous or arterial in origin and the second may be hemorragic, ischemic or provoked by other cause as the arterial dissection.

The aneurysmal bleeding   was   defined   as   a   haemorrhagic   stroke.  The   role   of   hormonal contraceptives (HCs) as a risk factor for cerebrovascular pathology is still discussed.

Various prospective and retrospective studies to establish the causal or casual relationship between HC use and stroke are necessary (38).

A recent study found that women using HCs had a relative risk for cerebrovascular accidents of 1.5.

The risk was increased at higher doses and for some specific progestins. No evidence supports a relationship between atherogenic disease and use of COCs. Former users of HCs do not have an increased risk of ischaemic stroke (38).

In addition, it is important to evaluate the relationship between migraine and stroke considering the high prevalence of migraine in young women. (39).

It is reported that a significant association between migraine with aura and juvenile stroke in women exist with the odds ratio of 2.11 in women aged under 46 years and 3.26 under the age of 35 (40,41)

Migraine with visual aura was associated with an increased risk of stroke;  particularly, those who smoke and with other medical conditions associated,  when take oral contraceptives markedly increase the risk (40,41).

There   is   insufficient   information   to   determine   whether   major differences in the risk of ischaemic stroke exist between products.

Current users appear to have a modestly elevated risk of haemorrhagic stroke, mainly in women older than 35 years; former users do not. Cases of transitory ischemic attacks in women   with   migraine   have   been   reported, also   with   progesterone-only preparation (42).

In most cases of myocardial infarction or stroke, one or more risk factors were identified (39,43 ).

Cerebral vein and sinus thrombosis may occur in COC users affected by congenital thrombophilia,  especially if prothrombotic conditions like hyperhomocysteinemia, nephrotic syndrome, or if unknown, dural arteriovenous malformations are present (19).  Fortunately,  these findings are reported only in sporadic cases.

It is essential to provide the preventive diagnosis with the aim to avoid a probable high risk for the woman;  therefore,  recent research has shown the influence of the type of progestin.  Despite the limited data,it seems that progestin-only-contraceptive does not increase the risk of heart attack and stroke.

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