The risk of stroke is very low in the age group of women who use contraception, but the incidence rises steeply from 3.4 per 100000 at ages 15 to 19 years to 64.4 per 100000 in women IS Risk The cumulative risk of stroke in women using OC pills has been summarized in 4 different meta-analyses, with many of the same individual cohort or case-control studies included in each. A meta-analysis of 16 case-control and cohort studies between 1960 and 1999 estimated a 2.75-fold increased odds (95% CI, 2.24 3.38) of stroke associated with any OC use.215 A later meta-analysis of 20 studies published between 1970 and 2000 that separated the studies by design (case-control versus cohort) found no increased risk of stroke in the cohort studies but an increased risk with OC use in case-control stud- Importantly, only 2 of the 4 cohort studies reported strokes by subtype, and risk was increased for IS but not hemorrhagic strokes.216 An additional meta-analysis of studies from 1980 to 2002 limited only to low-dose combined OCs (second and third generation only) also showed a comparable increased risk with OC use (OR, Lastly, a systematic review of progestogen-only OCs revealed no significant increased risk of stroke with this form of contraceptive.218 Two additional large cohort studies have been published since these meta-analyses. The first is the Women s Lifestyle and Health Cohort Study. This cohort comprised 49259 Swedish women who were followed up from 1991 to 1992 In the 285 cases of incident stroke that included ischemic, hemorrhagic, and unknown types, there was no significant association between OC use, duration, or type of OC. 