Risk of Pseudotumor Cerebri Syndrome (PTCS) with hormonal contraceptive use


  • Mohit Sodhi Department of Ophthalmology and Visual Sciences, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
  • Claire A. Sheldon Department of Ophthalmology and Visual Sciences, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
  • Bruce Carleton Division of Translational Therapeutics, Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, Canada Children’s Hospital Research Institute, University of British Columbia, Vancouver, Canada
  • Mahyar Etminan Department of Ophthalmology and Visual Sciences, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada




Benign intracranial hypertension, Case-control study, Estrogen, Hormones, Hormonal contraceptives, Oral contraceptives


Background: Hormonal contraceptives (HC), one of the most prescribed classes of medication in women, have been linked with pseudotumor cerebri syndrome (PTCS). To date, no large epidemiologic study has examined this association.

Methods: A case-control study using the IMS LifeLink Pharmetrics Plus database was conducted. Cases had an ICD-9-CM code for benign intracranial hypertension as well as a procedural code for a CT or MRI and a code for lumbar puncture procedure within 15 days of the PTCS code. Controls were selected from the cohort using density-based sampling.

Results: From a cohort of 9,053,240 subjects, there were 288 cases of PTCS corresponding to 2,880 controls. The adjusted RRs for two or more prescriptions of oral combined contraceptive was 0.62 (95% confidence interval 0.39-0.99). RRs for overall HC use was 0.91 (95% CI 0.39-2.12) for one prescription of HCs and 0.69 (95% CI 0.45-1.05) for two or more prescriptions. The RRs for one and two or more prescriptions of progestin only HCs were 0.75 (95% CI 0.08-7.46) and 1.06 (95% CI 0.42-2.69), respectively.

Conclusions: Overall HC use does not have a significant effect on incidence of PTCS, however harm associated with progestin-only contraceptives cannot be excluded.


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Original Research Articles