NEW data show that hormonal contraceptive use may lower major cardiovascular risks for many women, although this protective effect appears absent in those living with posttraumatic stress disorder.
Stress Disorders and Hormonal Contraceptive Use in Women’s
Stress related psychiatric disorders such as depression, anxiety and posttraumatic stress disorder are common in women of reproductive age and are increasingly recognised as important influences on cardiovascular health. The relationship between mental health and cardiovascular disease has prompted closer scrutiny of sex specific exposures, including hormonal contraceptive use. Until now, little large scale evidence has explored whether hormonal contraceptive use modifies cardiovascular and thrombotic risk differently in women with psychiatric diagnoses, leaving clinicians with limited data to guide personalised risk discussions.
Hormonal Contraceptives and Cardiovascular Outcomes
Researchers analysed electronic health record data from 31 824 women aged 18 to 55 years enrolled in a hospital-based biobank. More than one third of participants had a history of hormonal contraceptive use, accounting for 11 950 women or 37.6%. Stress related psychiatric disorders were prevalent, with depression affecting 9116 women or 28.5%, anxiety affecting 3533 women or 11.1% and posttraumatic stress disorder affecting 1992 women or 6.3%. Analyses showed that depression and anxiety did not modify associations between hormonal contraceptive use and major adverse cardiovascular events or deep vein thrombosis. However, posttraumatic stress disorder modified the relationship with major adverse cardiovascular events. Women without posttraumatic stress disorder who used contraceptives had lower odds of major adverse cardiovascular events with an odds ratio of 0.69; 95% CI, 0.87-3.24. In contrast, women with posttraumatic stress disorder had an odds ratio of 1.68; 95% CI, 0.87-3.24, which was not statistically significant.
Clinical Implications and Future Directions
These findings indicate that hormonal contraceptive use may confer cardiovascular protection for many women, but not for those with posttraumatic stress disorder. In clinical practice, this highlights the need for tailored cardiovascular risk assessments that incorporate both psychiatric history and contraceptive use. Future research is required to clarify biological mechanisms in women with posttraumatic stress disorder and to support more precise, individualised cardiovascular prevention strategies.
Reference
Thomas JL et al. Hormonal contraceptive use, stress disorders, and cardiovascular and thrombotic risk in women. JAMA Netw Open. 2026;9(1):e2551878.
