Women with post-traumatic stress disorder (PTSD) may have more negative cardiovascular outcomes when taking hormonal contraceptives compared with women who have other stress-related disorders, a new study shows. Other disorders, such as depression or anxiety, were not associated with adverse cardiovascular outcomes. Jordan L. Thomas, PhD, of the National Center for PTSD, Boston, and colleagues, reported the corresponding data in a manuscript published Wednesday online in JAMA Network Open. Stress can heavily influence women’s heart health and overall well-being. More research is needed on sex-specific factors on women’s cardiovascular health, such as hormonal contraceptives (also known as birth control). Investigators in this retrospective, cohort study examined the relationship between stress-related psychiatric disorders and hormonal contraceptives as it pertains to cardiovascular and thrombotic risk. Electronic health record data were collected from the Massachusetts General Brigham biobank before September 12, 2020. Data from women aged 18-55 years were analyzed from May 2, 2024, through November 3, 2025. Depression, anxiety and PTSD, as defined in the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) were the stress-related psychiatric disorders assessed as separate diagnoses in this study. Hormonal contraceptive use was also assessed, and this usage was defined by RxNorm codes. Major adverse cardiovascular events (MACE), defined as infarction, unstable chest pain, heart failure, coronary revascularization, peripheral vascular disease, peripheral revascularization, stroke or transient ischemic attack, and deep vein thrombosis (DVT) were the co-primary outcomes in this study. A total of 31,824 women (mean age=38.5 years; 78.7% White, 6.0% Black, 4.3% Asian) were included in this study, and 37.6% of them had used hormonal contraceptives at some point in their lives. Depression was present in 28.5% of women, 11.1% had anxiety and 6.3% had PTSD. Neither depression nor anxiety moderated the associations between using hormonal contraception and the primary outcomes of MACE or DVT. However, PTSD did modify the association between hormonal contraception and MACE but did not make a difference in DVT. After stratification, analysis showed that only women who did not have PTSD who also used hormonal contraceptives had lower rates of MACE (odds ratio [OR]=0.69; 95% confidence interval [CI]=0.87-3.24). Among women with PTSD, the OR was >1 (1.68; 95% CI=0.87-3.24), but findings were not statistically significant. The authors of this manuscript noted several limitations of this study: diagnostic misclassification and lack of validation of diagnosis across providers, lack of diversity and lack of the presence of the primary outcomes. Overall, women with PTSD may have unique cardiovascular outcomes after or while taking hormonal contraceptives, compared with women who have other stress-related psychiatric disorders, such as depression or anxiety. Source: Thomas JL, Ellis RA, AbiKaram K, et al. Hormonal contraceptive use, stress disorders and cardiovascular and thrombotic risk in women. JAMA Network Open. 2026 January 1 (Article in Press). Image Credit: StockMe – stock.adobe.com