Low-Dose Birth Control Pill May Up Heart Risk
But Researchers Say Risk of Heart Attack and Stroke Still Very Low for Most Women
Rethinking PCOS Treatment
He points out, however, that oral contraceptives are the preferred treatment for polycystic ovary syndrome (PCOS), a hormonal imbalance that is one of the most common causes of infertility. The syndrome is also associated with a high risk of type 2 diabetes, related to insulin resistance, abnormal periods, and excess male hormones.
It is estimated that as many as 2 million women in the U.S. have both PCOS and metabolic syndrome, a cluster of risk factors that increases heart disease and type 2 diabetes risk. These women are typically overweight or obese and have insulin resistance. They may also have high blood pressure, low HDL "good" cholesterol, and high triglycerides, a blood fat also linked to diabetes risk.
Nestler points out that a woman with PCOS may end up taking oral contraceptives for several decades to treat many of the symptoms of the condition. They are also used to make menstrual cycles regular -- thought to be key in treating the condition.
Nestler says insulin-sensitizing drugs like Glucophage may be a safer alternative to contraceptives in women who may already have a higher-than-normal risk for heart disease.
"There is at least the possibility that oral contraceptives may not represent optimal therapy for PCOS and perhaps metabolic syndrome, and I think this deserves study," he says.
New York cardiologist Nieca Goldberg, MD, tells WebMD that even young women who begin using oral contraceptives should be screened for heart disease risk. Goldberg is chief of the Women's Heart Program at Lenox Hill Hospital in New York and is the author of the book Women are Not Small Men: Life-Saving Strategies for Preventing and Healing Heart Disease in Women.
"When a woman is considering her birth control options, that is an ideal time to be screened for heart disease risk," she says. "If we did that on a routine basis we could identify high-risk women early and reduce heart disease later in life."