Risk And Benefit Assessment Of Hormonal Contraceptive Use In Women With Risk Factors For Cardiovascular Disease: A Systematic Review

The use of hormonal contraceptives is one of the most effective strategies for reproductive control, but their safety in women with cardiovascular risk factors remains a widely debated topic. This systematic review aimed to evaluate the risks and benefits of hormonal contraceptive use in women with predisposing conditions, such as hypertension, obesity, smoking, thrombophilia, and migraine with aura. Twenty-five studies between 2000 and 2025 were included, comprising population cohorts, case-control studies, meta-analyses, and scientific society guidelines. The results demonstrated a consistent association between the use of combined hormonal contraceptives (CHCs) and an increased risk of venous thromboembolism (VTE), especially in formulations containing third- and fourth-generation progestogens (desogestrel, gestodene, and drospirenone). In addition, evidence points to a higher risk in users of transdermal patches and vaginal rings compared to levonorgestrel pills. Arterial events, such as ischemic stroke and myocardial infarction, have also been shown to be more frequent among CHC users with associated risk factors, especially in women with migraine with aura, smokers over 35 years of age, and hypertensive patients. In contrast, progestin-only contraceptives, such as implants, continuous pills, and the levonorgestrel-releasing intrauterine system, did not show a significant increase in thrombotic or cardiovascular risk and are safer options for more vulnerable populations. On the other hand, non-contraceptive benefits have been consistently reported, including a sustained reduction in the risk of endometrial and ovarian cancer, an effect associated with duration of use and with a prolonged protective impact after discontinuation. It is concluded that the prescription of hormonal contraceptives should be individualized, balancing cardiovascular risks and additional benefits, in line with the recommendations of the main international guidelines.