TOPLINE:

The use of combined hormonal birth control was associated with a reduced risk for major adverse cardiovascular events in women with or without depression or anxiety. This protective effect did not extend to those with posttraumatic stress disorder (PTSD).

METHODOLOGY:

• In this retrospective cohort study, investigators assessed whether having stress-related psychiatric conditions influenced how the use of combined hormonal birth control affects the risk for major heart problems or deep vein blood clots.
• They reviewed health records of 31,824 women aged 18-55 years (mean age, 38.5 years) who consented to be included in a hospital-based biobank in the US on or before September 12, 2020.
• Researchers used diagnostic codes to identify stress-related disorders diagnosed before enrollment. Depression was present in 28.5% of women, anxiety in 11.1% of them, and PTSD in 6.3% of them.
• Researchers also used prescriptions to determine whether the women used hormonal contraceptives before enrollment; 37.6% women used combined hormonal contraceptives.
• Investigators used diagnostic codes to identify major adverse cardiovascular events and deep vein thromboses that occurred after enrollment.

TAKEAWAY:

• Overall, 1.5% of women had major adverse cardiovascular events and 0.9% had deep vein thrombosis. The use of combined hormonal contraceptives was linked to 30% reduced odds of having major adverse cardiovascular events (adjusted odds ratio [aOR], 0.70; P = .002).
• Depression or anxiety did not modify this association, with the use of combined hormonal contraceptives linked to a reduced cardiovascular risk regardless of these conditions.
• PTSD significantly modified the association between the use of hormonal contraceptives and the risk for major adverse cardiovascular events (interaction coefficient b, 0.69; P = .003).
• Among women without PTSD, contraceptive use was associated with 31% reduced odds of major adverse cardiovascular events (P = .001). In those with PTSD, contraceptive use showed a nonsignificant trend toward an increased risk for major adverse cardiovascular events (aOR, 1.68; P = .12).

IN PRACTICE:

“In this cohort study of 31,824 women enrolled in large, hospital-based biobank, we found preliminary evidence that hormonal contraceptive use contributed to the impact of specific stress-related psychopathologies — namely, PTSD — on adverse cardiovascular outcomes,” the investigators reported.

SOURCE:

This study was led by Jordan L. Thomas, PhD, of Veterans Affairs Boston Healthcare System in Boston. It was published online on January 02, 2026, in JAMA Network Open.

LIMITATIONS:

This study used diagnostic codes, which may have misdiagnosed the conditions. Severity, course, and timing of contraceptives were not captured. The cohort was mostly White, non‑Hispanic patients from Boston, which limited generalizability.

DISCLOSURES:

Several authors reported receiving funding from multiple organizations including the National Institute of Mental Health, the National Institute of General Medical Sciences, and the National Institutes of Health. Some authors reported receiving personal fees, grants, and/or having stocks in pharmaceutical, biotechnology, and healthcare companies including Amissa Health, Boston Scientific, and GE Healthcare.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.