Speaking on stroke prevention in the `90s, Dr. Steven Kittner, associate professor of neurology at the medical school in Baltimore, presented data from observational studies indicating a 28-fold increased risk of intracerebral hemorrhage and a nine-fold increase in risk of cerebral infarction in women during the six weeks after delivery.

Pregnancy itself is associated with no increased risk of cerebral infarction and only a modestly increased risk of intracerebral hemorrhage, Kittner said.

Oral contraceptives seem to cause a dose-associated increased risk of stroke, said Kittner. "Current research supports the accepted practice of restricting the use of oral contraceptives in women who smoke cigarettes, have a history of hypertension or other risk factors for vascular disease," he said.

The relationship between postmenopausal estrogen replacement therapy and stroke remains less clear, the neurologist said. One large study showed a significantly increased risk of stroke both among women taking estrogen alone and those taking combination hormone replacement therapy of estrogen and progestin. But another study showed a significantly reduced risk of stroke in women taking combination hormone replacement therapy.

Several large clinical trials now under way should provide more definitive data, but for now, "there still are only two well established indications for hormone replacement therapy, relief of menopausal symptoms and prevention of osteoporosis," Kittner said. "Many uncertainties persist regarding the risk of combined estrogen-progestin therapy, and the risks/benefits need to be weighed in each individual case.

Note: If no author is given, the source is cited instead.

• Gynecology
• Menopause
• Hormone Disorders
• Stroke Prevention
• Women's Health
• Gene Therapy

• Hormone replacement therapy
• Menopause
• Hysterectomy
• Estrogen
• Stroke
• Gynecologic hemorrhage