Study Suggests Hormonal Contraceptives Lower Heart Risk—Except in Women with PTSD

Understanding the Intersection of Women’s Mental and Cardiovascular Health

Cardiovascular disease remains the leading cause of death among women in the United States, with stress-related psychiatric disorders like depression, anxiety, and PTSD playing an increasingly recognized role. Hormonal contraceptives, used by millions, have long been scrutinized for their potential heart risks—but how do stress disorders influence these effects?

A new study, published in JAMA Network Open, delves into this intersection, exploring whether a history of stress-related disorders changes the link between hormonal contraceptive use and cardiovascular or thrombotic risk.

The Study at a Glance: Who and What Was Studied?

Researchers analyzed health records from over 31,800 women aged 18 to 55, consented to a large US hospital biobank. They examined lifetime use of combined hormonal contraceptives (like the pill) and diagnoses of depression, anxiety, or PTSD. The main outcomes were major adverse cardiovascular events (MACE)—such as heart attacks and strokes—and deep vein thrombosis (DVT).

The key question: Does having a stress-related disorder modify the relationship between hormonal contraceptive use and heart or clotting risks?

What Did They Find? A Surprising Twist for PTSD

Protective in Most, But Not All: Among women without PTSD, those using hormonal contraceptives had about a 31% lower risk of major heart events. Depression and anxiety did not alter this benefit.

PTSD Changes the Picture: For women with PTSD, hormonal contraceptive use was not linked to reduced heart risk. In fact, the odds of a major cardiovascular event were higher, though not significantly so.

No Impact on Clot Risk: Across all groups, contraceptive use did not significantly affect the risk of DVT.

Type of Contraceptive Didn’t Matter: Whether women used earlier or newer generations of hormonal contraceptives, the results were similar.

These findings suggest that PTSD may uniquely alter how hormonal contraceptives impact heart health—a nuance that could inform future research and clinical care.

Why Does PTSD Make a Difference?

Researchers speculate that PTSD’s distinct effects on the body—heightened sympathetic arousal, chronic stress response, and impaired fear learning—may interact with hormonal changes in ways that increase cardiovascular vulnerability. Unlike depression or anxiety, PTSD’s physiological impact could override the heart-protective effects seen with contraceptive use in other women.

Key Takeaways

Hormonal contraceptives are associated with lower heart risk in women without PTSD.

PTSD may negate the cardiovascular benefits of hormonal contraceptive use.

No significant link between contraceptive use and blood clot risk was found.

Different contraceptive generations did not change the results.

These insights highlight the importance of considering mental health, especially PTSD, when evaluating heart risk in women using hormonal contraception.

Citation:

Thomas JL, Ellis RA, AbiKaram K, et al. Hormonal Contraceptive Use, Stress Disorders, and Cardiovascular and Thrombotic Risk in Women. JAMA Network Open. 2026;9(1):e2551878. doi:10.1001/jamanetworkopen.2025.51878.