Three efficient types of contraception comprise the hormone estrogen: the contraception patch, mixed hormonal contraception tablets, and a vaginal ring. Doctors have sometimes really helpful that girls keep away from contraception with estrogen if they’ve hypertension, which present US pointers outline as 130 mm Hg systolic strain and 80 mm Hg diastolic strain, or greater. A current scientific replace in JAMA clarifies whether or not it’s secure for some girls with hypertension to make use of these types of contraception.
Why does blood strain matter when selecting contraception?
Birth management containing estrogen can enhance blood strain. When girls who’ve hypertension use these contraception strategies, they’ve an elevated danger of stroke and coronary heart assault in contrast with girls who should not have hypertension. However, their precise possibilities of having a stroke or a coronary heart assault are nonetheless fairly low.
When contemplating contraception choices, it’s essential to additionally weigh the doable dangers of an unintended being pregnant. A lady who has a historical past of hypertension earlier than she turns into pregnant is extra more likely to expertise
- preeclampsia, a being pregnant complication that may have an effect on liver and kidney operate and may even result in eclampsia, or seizures
- diabetes throughout being pregnant
- blood clots
- coronary heart assault
She’s additionally at greater danger for issues with fetal development and preterm start.
Why are suggestions round blood strain and contraception being up to date?
When US blood strain pointers modified in 2017, many extra folks have been identified with hypertension. That occurred as a result of the brand new pointers tightened requirements, as follows:
- regular blood strain is lower than 120 (systolic)/80 (diastolic) mm Hg
- elevated blood strain is between 120 and 129 mm Hg (systolic) and fewer than 80 mm Hg (diastolic)
- hypertension is 130 mm Hg (systolic) and 80 mm Hg (diastolic) or greater.
With these up to date definitions, practically half of American adults have hypertension. Black girls are at notably excessive danger: greater than half of Black girls over the age of 19 are identified with hypertension.
If a girl has hypertension, the JAMA replace recommends weighing three components earlier than beginning an estrogen-containing contraception: a girl’s age, management of blood strain, and every other dangers for coronary heart illness.
- Safe to make use of contraception containing estrogen: If girls are 35 years previous or youthful, have nicely managed blood strain, and are wholesome, estrogen-containing contraception can be utilized. Be certain to have a well being skilled examine blood strain inside one month of beginning such a contraception. Additionally, routine blood strain checks are really helpful twice a yr.
- Should keep away from contraception containing estrogen: If girls are older than 35, even when they’ve nicely managed blood strain, estrogen-containing contraception ought to be averted. Similarly, girls of any age who’ve a number of danger components for coronary heart illness or who’ve uncontrolled hypertension shouldn’t use contraception containing estrogen. These girls additionally shouldn’t use the contraception shot (Depo-Provera) as a result of it might enhance ldl cholesterol and result in an elevated danger of stroke, in line with the overview. (This remedy accommodates a distinct hormone referred to as progestin.)
The JAMA replace reviewed proof based mostly on an older definition of hypertension within the context of contraception use. Further analysis is required to raised perceive how completely different ranges of blood strain would possibly have an effect on girls utilizing contraception that accommodates estrogen. However, it’s unlikely that these suggestions would change additional based mostly on the newer definition of hypertension.
Which contraception strategies don’t comprise estrogen?
So, what can girls who’re unable to make use of contraception containing estrogen use to stop being pregnant? The excellent news is that there are a selection of different contraception strategies accessible, each hormonal and nonhormonal.
- The most dependable types of contraception with out estrogen are the copper intrauterine gadget (IUD), the hormonal IUD, the implant, and sterilization for girls or males.
- Nonhormonal strategies embody the copper IUD, condoms for males or girls, cervical cap, and diaphragm.
- Three progestin-only hormonal strategies are secure to make use of: the minipill, the contraception implant, or the hormonal IUD. However, the contraception shot (Depo-Provera) isn’t really helpful for girls who’ve poorly managed hypertension.
If you do have hypertension, train and dietary modifications stay an essential part of sustaining your coronary heart well being. Discuss along with your physician which contraception choices is perhaps finest for you, so that you just and your physician can have interaction in shared decision-making about your preferences.
See the Harvard Health Birth Control Center for extra data on choices.