Cerebral venous thrombosis (CVT) is a rare but significant cause of stroke in young women, accounting for 0.5–1% of all cerebrovascular events, with hormonal factors playing a central etiological role. This comprehensive review examines the relationship between exogenous hormonal use – including oral contraceptives (OCPs), non-oral preparations, and hormone replacement therapy (HRT) and CVT risk in women. A broad literature search was undertaken using PubMed, Cochrane Library, Excerpta Medica Database (EMBASE), Scopus, and other databases, focusing on studies published after 2005. The analysis demonstrates that estrogen-containing combined oral contraceptives (COCs) increase the risk of CVT approximately 5–7 times compared with non-users, predominantly due to estrogen-induced hypercoagulability through increased procoagulant factors and suppression of natural anticoagulants. This risk is further amplified in women with inherited thrombophilia such as Factor V Leiden and prothrombin G20210A mutations, obesity, or smoking. Third- and fourth-generation COCs, containing newer progestins like drospirenone or desogestrel, confer higher thrombogenic potential, while second-generation, low-dose levonorgestrel-based COCs exhibit relatively lower risk. Clinical manifestations of OCP-related CVT are nonspecific, with headache being the most frequent symptom, emphasizing the need for early magnetic resonance (MR) imaging or MR venography for diagnosis. Non-oral hormonal preparations (transdermal patches and vaginal rings) show a modest increase in thrombotic risk, though current evidence remains insufficient to confirm their safety for CVT specifically. Regarding HRT, epidemiological data indicate a 2–5-fold elevated venous thrombosis risk, with the highest risk during the 1 st year of therapy; oral HRT is associated with a greater thrombotic burden than transdermal formulations, as confirmed by the ESTHER study and recent meta-analyses. Overall, these findings underscore the importance of individualized risk assessment, especially for women with predisposing conditions such as thrombophilia, hypertension, or metabolic syndromes. In conclusion, low-dose, second-generation levonorgestrel-based COCs or progestin-only formulations are considered the safest hormonal options in women at risk of CVT, while transdermal estrogen remains the preferred route for menopausal hormone therapy.
Gupta et al. (Fri,) studied this question.
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