Authors : Manisha Gupta, Vishakha Anu, Abhishek Kumar
DOI : 10.25259/ijcdw_13_2025
Volume : 5
Issue : 1
Year : 2026
Page No : 1-12
Cerebral venous thrombosis (CVT) is a rare but significant cause of stroke in young women, accounting for 0.5–1% of all cerebrovascular events, with hormonal factors playing a central etiological role. This comprehensive review examines the relationship between exogenous hormonal use – including oral contraceptives (OCPs), non-oral preparations, and hormone replacement therapy (HRT) and CVT risk in women. A broad literature search was undertaken using PubMed, Cochrane Library, Excerpta Medica Database (EMBASE), Scopus, and other databases, focusing on studies published after 2005. The analysis demonstrates that estrogen-containing combined oral contraceptives (COCs) increase the risk of CVT approximately 5–7 times compared with non-users, predominantly due to estrogen-induced hypercoagulability through increased procoagulant factors and suppression of natural anticoagulants. This risk is further amplified in women with inherited thrombophilia such as Factor V Leiden and prothrombin G20210A mutations, obesity, or smoking. Third- and fourth-generation COCs, containing newer progestins like drospirenone or desogestrel, confer higher thrombogenic potential, while second-generation, low-dose levonorgestrel-based COCs exhibit relatively lower risk. Clinical manifestations of OCP-related CVT are nonspecific, with headache being the most frequent symptom, emphasizing the need for early magnetic resonance (MR) imaging or MR venography for diagnosis. Non-oral hormonal preparations (transdermal patches and vaginal rings) show a modest increase in thrombotic risk, though current evidence remains insufficient to confirm their safety for CVT specifically. Regarding HRT, epidemiological data indicate a 2–5-fold elevated venous thrombosis risk, with the highest risk during the 1 st year of therapy; oral HRT is associated with a greater thrombotic burden than transdermal formulations, as confirmed by the ESTHER study and recent meta-analyses. Overall, these findings underscore the importance of individualized risk assessment, especially for women with predisposing conditions such as thrombophilia, hypertension, or metabolic syndromes. In conclusion, low-dose, second-generation levonorgestrel-based COCs or progestin-only formulations are considered the safest hormonal options in women at risk of CVT, while transdermal estrogen remains the preferred route for menopausal hormone therapy.