Oral contraceptive and hormone replacement therapy in women with cerebral aneurysms
- 1Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
- 2Department of Neurological Surgery, Virginia Commonwealth University, Richmond, Virginia, USA
- Correspondence to Dr M Chen, Rush University Medical Center, 1725 W Harrison St, Suite 1121, Chicago, IL 60612, USA;
Contributors LF conceived the study, participated in the design of the study, helped to design the study questionnaire used, helped to collect the data and helped to draft the manuscript. MC oversaw the design of the study, organized the appropriate use of control data, oversaw the statistical analysis of the data and helped to draft the manuscript. BO designed and executed the statistical analysis of all data reported. LG-S participated in the design of the study questionnaire and collected the majority of the data included.
- Received 24 September 2010
- Revised 14 November 2010
- Accepted 24 November 2010
- Published Online First 17 December 2010
Background It is well known that cerebral aneurysms occur more frequently in women, with numerous studies suggesting a role for hormones in aneurysm pathogenesis. Estrogen promotes normal physiologic vascular endothelial function but also fluctuates during the menstrual cycle and drops significantly at menopause.
Methods A retrospective, case control study was conducted to determine if exogenous estrogen use, which stabilizes estradiol levels, had any association with the presence of cerebral aneurysms. 60 women with intradural cerebral aneurysms were interviewed about their basic medical and female reproductive health histories, including oral contraceptive pill and hormone replacement therapy use and duration of use. This information was compared with the same data collected from women in the general public, as represented by 4682 women contacted through random digit phone dialing in the National Institute of Child Health and Human Development sponsored Contraceptive and Reproductive Experiences Study, published in 2002.
Results Multivariate logistic regression showed a significant association between a lower rate of oral contraceptive (OR 2.1, CI 1.17 to 3.81; p=0.01) and hormone replacement therapy (OR 3.09, CI 1.54 to 6.22; p=0.002) use and the presence of a cerebral aneurysm.
Conclusion These data suggest that exposure to exogenous estrogen agents in women is associated with a lower frequency of cerebral aneurysms.
Competing interests None.
Ethics approval This study was conducted with the approval of the Rush University Medical Center Institutional Review Board, ORA No 09101201-GR01.
Provenance and peer review Not commissioned; externally peer reviewed.