Hormonal contraceptives show differing heart risks among stressed women

Antonia Seligowski, PhD, of the Neurocardiac Effects of Stress & Trauma Laboratory within the Department of Psychiatry at Mass General Brigham, is the senior author of a paper published in JAMA Network Open, "Hormonal contraceptive use, stress disorders, and cardiovascular and thrombotic risk in women."

Q: What challenges or unmet needs make this study important?

Over 400,000 women in the United States die each year from cardiovascular disease (CVD), the nation's leading cause of death. Stress is a major risk factor for CVD, and stress‑related psychiatric disorders like anxiety and post-traumatic stress disorder (PTSD) are more common in women. Because of this, experts have called for more attention to be paid to sex‑specific factors that contribute to women's cardiovascular health.

One such factor is hormonal contraception, used by about 9.1 million women in the United States. Past research on these contraceptives-which work by introducing different amounts of hormones and suppressing natural estradiol and progesterone levels-has focused almost entirely on young, relatively healthy women. As a result, very little is known about how hormonal contraceptives affect women with stress‑related psychiatric disorders. To our knowledge, this study is the first to examine the combined effects of hormonal contraceptives and stress‑related disorders on cardiovascular or thrombosis risk. 

Q: What central question(s) were you investigating?

Our study, led by Jordan Thomas, PhD, of the University of Kansas, explored whether hormonal contraceptive use is linked to cardiovascular and thrombotic risk in women with and without stress‑related disorders. Specifically, we wanted to know if women with a history of depression, anxiety or PTSD who use hormonal contraceptives have a higher risk of major adverse cardiovascular events (MACE) or deep‑vein thrombosis than those without this mental health history.

Q: What methods or approach did you use?

We analyzed healthcare records from 31,824 women who consented to be part of the Mass General Brigham Biobank. Specifically, we looked for medical codes indicating diagnoses of stress‑related disorders, MACE and deep‑vein thrombosis, as well as prescriptions for hormonal contraceptives.

Q: What did you find?

For the majority of women, including those with a history of anxiety or depression, hormonal contraceptive use was associated with lower risk of MACE. However, this protective association was not seen in women with PTSD.

Although preliminary, these findings suggest that cardiovascular risk may vary among women who use hormonal contraceptives-especially differing for those with PTSD. If future studies confirm these results, clinicians may need to consider stress‑related psychiatric disorders when discussing hormonal contraceptive options with patients.

Q: Tell us about any follow-up studies you have planned to validate or build on these findings.

We hope to conduct a clinical study that collects new data on how specific hormonal contraceptive formulas relate to CVD risk factors in women, including blood pressure, vascular endothelial function and blood‑based clotting markers. We also plan to test whether these effects differ for women with and without stress‑related psychiatric disorders. Participants would return yearly for follow‑up visits to track clinical outcomes such as thrombotic events.