The Risk of MI and Ischemic Stroke with Combined Oral Contraceptives.

Evidence-Based Answer The overall risk of MI and ischemic stroke is increased in women who use combined oral contraceptives. The relative risk of MI and ischemic stroke increases as estrogen dose rises, increasing by 60% with doses of 20 mcg and more than doubling when doses of 50 mcg or more are used. Risk of MI and ischemic stroke does not vary with the type or generation of progestin. Physicians should be cautious when prescribing combined oral contraceptives because of the increased risk of MI and ischemic stroke.1 (Strength of Recommendation: B, based on limited-quality evidence from observational studies.)