Birth control pills, hormone therapy, and coronary artery disease

Birth control pills

Healthy, young, nonsmoking women probably do not increase their risk of coronary artery disease (CAD) when they take low-dose birth control pills (oral contraceptives). However, if a woman has other significant risk factors for CAD, taking birth control pills may further increase this risk. For instance, birth control pills are more likely to increase a woman's risk if she is older than 35 and smokes cigarettes.¹ Birth control pills may raise "bad" cholesterol (low-density lipoprotein, or LDL) and lower "good" cholesterol (high-density lipoprotein, or HDL).

Hormone therapy

Taking estrogen with or without progestin does not prevent coronary artery disease. In fact, if you are 10 or more years past menopause, taking hormone therapy may raise your risk of coronary artery disease.² Talk to your doctor about your risks with hormone therapy. And carefully weigh the benefits against the risks of taking it. If you need relief for symptoms of menopause, hormone therapy is one choice you can think about. But there are other types of treatment for problems like hot flashes and sleep problems. For more information, see the topic Menopause and Perimenopause.

The study called the Women's Health Initiative found that for a small number of women, taking estrogen with progestin led to breast cancer, heart attack, stroke, blood clots (pulmonary embolism and deep vein thrombosis), and Alzheimer’s disease and other dementias.³ (For women who used hormone therapy during the first 10 years after menopause, hormones did not cause heart problems.²)

Citations

1. Sweitzer NK, Douglas PS (2004). Cardiovascular disease in women. In DP Zipes et al., eds., Braunwald's Heart Disease, 7th ed., pp. 1951–1964. Philadelphia: Elsevier Saunders.

2. Rossouw JE, et al. (2007). Postmenopausal hormone therapy and risk of cardiovascular disease by age and years since menopause. JAMA, 297(13): 1465–1477.

3. Manson JE, et al. (2003). Estrogen plus progestin and the risk of coronary heart disease. New England Journal of Medicine, 349(6): 523–534.