ORIGINAL RESEARCH article
Front. Neurol.
Sec. Stroke
This article is part of the Research TopicUpdate on the Diagnosis, Treatment, and Research of Cerebral Cavernous MalformationsView all 3 articles
Female Hormone Therapy and Risk of Intracranial Hemorrhage and Focal Neurological Deficits in Patients with Cavernous Malformations of the Central Nervous System
Provisionally accepted
Saskia Kim Wildi1,2*
Selina Nager2
Victor E. Staartjes1
Vittorio Stumpo1Sena Özkaratufan2Niklaus Krayenbühl3Oliver Bozinov4
Luca Regli5
Julia Velz1,2*- 1University Hospital Zürich, Zurich, Switzerland
- 2Universitat Zurich, Zürich, Switzerland
- 3Universitats-Kinderspital Zurich, Zürich, Switzerland
- 4HOCH Health Ostschweiz, St. Gallen, Switzerland
- 5UniversitatsSpital Zurich, Zürich, Switzerland
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Background: Female hormone therapy (FHT, birth control treatment and postmenopausal hormone replacement therapy (HRT)) is not withheld from patients with cerebral cavernous malformations (CCM), notwithstanding the uncertainty surrounding the impact of these medications on the risk of intracranial hemorrhage (ICH). This study aimed to evaluate the impact of female hormone therapy on the risk of ICH or focal neurological deficit (FND) in patients with CCM. Methods: The prospective institutional database was examined for all patients with CCM treated at our institution between 2006 and 2023. Inclusion criteria comprised patients with confirmed CCM diagnosis through radiological and/or histological examination, availability of baseline clinical characteristics, accessible medication history, and follow-up data. Patients were stratified based on their medical treatment regimen, which included female hormone therapy or no treatment. The study assessed the time-to-event probability and the number of events (ICH or FND) during the follow-up period. Results: A total of 328 female patients with CCM were included in the final analysis. Among them, 56 patients (17.1%) were receiving female hormone therapy. Specifically, 37 patients (11.3%) were using birth control treatments and 19 patients (5.8%) were on HRT. The mean number of ICH per patient was 0.43 (SD 1.11) in the FHT group and 0.38 (SD 0.8) in the control group (p = 0.1), while the mean number of FND was 0.36 (SD 0.84) in the FHT group and 0.28 (SD 0.66) in the control group (p = 0.58). The time to first ICH was 1631.5 days (SD 2324.6) in the FHT group and 1161.4 days (SD 1650.8) in the control group (p = 0.35), while the time to first FND was 1601.0 days (SD 1934.1) in the FHT group and 1208.1 days (SD 1649.5) in the control group (p = 0.86).
Keywords: female hormone therapy, Hemorrhage, Hemorrhagic event, Intracranial bleeding, intracranial hemorrhage, Neurological deficit
Received: 03 Jul 2025; Accepted: 26 Nov 2025.
Copyright: © 2025 Wildi, Nager, Staartjes, Stumpo, Özkaratufan, Krayenbühl, Bozinov, Regli and Velz. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Saskia Kim Wildi
Julia Velz
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