Stroke is a cerebrovascular event accompanied by a sudden onset of clinical signs. There are two main types of stroke. Acute ischemic strokes (IS) result from the obstruction of a cerebral artery causing brain ischemia, and hemorrhagic strokes (HS) are caused by rupture of a cerebral artery with consequent abnormalities in blood flow (Roach et al. 2015). The incidence of ischemic stroke is more frequent at 87%. The incidence of hemorrhagic stroke is less, but the mortality rate is higher (Virani et al., 2021, Katan and Luft, 2018). In general, stroke disproportionately kills more women than men and remains one of the leading causes of death and disability in the USA (Leppert et al., 2020, Demel et al., 2018, Chang et al., 2018). Young women suffer from stroke more frequently than young men (Leppert et al. 2020). Hormonal sex differences led to an increased lifetime risk of stroke, as well as worse stroke outcomes in women. The brain demonstrates a multitude of sex differences, some examples of which are neurodegenerative diseases such as stroke, as well as the effects of pharmacological drugs on the brains of males and females. This phenomenon gives sex-specific reduction in incidence or risk or sex-specific therapy a promising future. This suggests that it may be necessary that women be given a customized stroke treatment in order to account for their biological differences with men so that their incidence and risk of stroke may be decreased (Jamieson & Skliut 2009).

A recent study observed a sex difference in lesion topography that is specific to women, namely, acute stroke severity was linked to lesions in the left-hemispheric posterior circulation, and this also affected long-term outcomes (Bonkhoff et al. 2022). Despite such findings, studies understanding risk or mechanisms of stroke are conducted mainly on male experimental animals, and experiments on female animals have been neglected with the assumption that results from male studies would apply to females (Beery & Zucker 2011). Furthermore, female centered studies are commonly dismissed due to endogenous ovarian hormone fluctuations (Beery & Zucker 2011). Owing to the fundamental differences in pathology and its severity between male and female subjects (Hurn, 2014, Roy-O'Reilly and McCullough, 2014, Kim and Vemuganti, 2015), it is essential to study female specific risk factors for stroke prevention.

As per the American Heart Association, typical risk factors for stroke in men and women include hypertension, diabetes, hyperlipemia, atrial fibrillation, smoking and age. However, sex differences for stroke suggest that there are sex-specific comorbidities (Leppert et al. 2020). Beyond the typical risk factors for stroke, adverse pregnancy outcomes, migraine, sex hormone usage, and fertility impediments have been shown to induce vascular complications (Bushnell and Kapral, 2022, Demel et al., 2018, Allais et al., 2008, Okoth et al., 2020). Research has shown that comorbidities such as hypertension and tobacco smoking have negative synergism with oral contraception (OC), thus increasing the risk of stroke in women, yet the underlying mechanisms are not well understood (Chang et al. 1999). It has been reported women OC users have a two- to -five fold increased risk of stroke compared to non-users (Bushnell 2008). Oral contraceptive use for a long time is associated with an increased risk of arterial thrombosis and blood clotting - the causes of stroke (Roach et al. 2015). Research has shown that the risk of IS and total stroke increases per every 10 μg estrogen and five-year duration of OC use, but there was a minimal significance seen between duration of OC use and HS (Li et al. 2019). The goal of the current review is to revisit the available literature regarding the impact of OC use on stroke, to explain possible underlying mechanisms, and to identify gaps in our understanding to promote future research to reduce and cure stroke in OC users.