Contraception and hypertension: Which strategies are protected for you? – Harvard Well being Weblog


Three efficient types of contraception comprise the hormone estrogen: the contraception patch, mixed hormonal contraception drugs, and a vaginal ring. Medical doctors have usually advisable that girls avoid birth control with estrogen if they’ve hypertension, which current US guidelines outline as 130 mm Hg systolic strain and 80 mm Hg diastolic strain, or greater. A current clinical update in JAMA clarifies whether or not it’s protected for some ladies with hypertension to make use of these types of contraception.

Why does blood strain matter when selecting contraception?

Contraception containing estrogen can improve blood strain. When ladies who’ve hypertension use these contraception strategies, they’ve an elevated threat of stroke and coronary heart assault in contrast with ladies who shouldn’t have hypertension. Nonetheless, their precise probabilities of having a stroke or a coronary heart assault are still quite low.

When contemplating contraception choices, it’s vital 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 threat for issues with fetal development and preterm beginning.

Why are suggestions round blood strain and contraception being up to date?

When US blood strain tips modified in 2017, many extra folks have been identified with hypertension. That occurred as a result of the brand new tips 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, nearly half of American adults have hypertension. Black ladies are at notably excessive threat: more than half of Black women over the age of 19 are identified with hypertension.

If a girl has hypertension, the JAMA replace recommends weighing three elements earlier than beginning an estrogen-containing contraception: a girl’s age, management of blood strain, and every other dangers for coronary heart illness.

  • Secure to make use of contraception containing estrogen: If ladies are 35 years previous or youthful, have properly managed blood strain, and are wholesome, estrogen-containing contraception can be utilized. Make sure to have a well being skilled examine blood strain inside one month of beginning this sort of contraception. Moreover, routine blood strain checks are advisable twice a yr.
  • Ought to keep away from contraception containing estrogen: If ladies are older than 35, even when they’ve properly managed blood strain, estrogen-containing contraception must be prevented. Equally, ladies of any age who’ve a number of threat elements for coronary heart illness or who’ve uncontrolled hypertension shouldn’t use contraception containing estrogen. These ladies additionally shouldn’t use the birth control shot (Depo-Provera) as a result of it could improve ldl cholesterol and result in an elevated threat of stroke, in accordance with the assessment. (This remedy comprises a distinct hormone known as progestin.)

The JAMA replace reviewed proof based mostly on an older definition of high blood pressure within the context of contraception use. Additional analysis is required to higher perceive how completely different ranges of blood strain would possibly have an effect on ladies utilizing contraception that comprises estrogen. Nonetheless, 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 ladies 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 obtainable, each hormonal and nonhormonal.

  • The most reliable forms of birth control with out estrogen are the copper intrauterine gadget (IUD), the hormonal IUD, the implant, and sterilization for girls or males.
  • Nonhormonal methods embrace the copper IUD, condoms for males or ladies, cervical cap, and diaphragm.
  • Three progestin-only hormonal strategies are protected to make use of: the minipill, the birth control implant, or the hormonal IUD. Nonetheless, the contraception shot (Depo-Provera) isn’t advisable for girls who’ve poorly managed hypertension.

Should you do have hypertension, train and dietary modifications stay an vital element of sustaining your coronary heart well being. Focus on together with your physician which contraception choices is likely to be greatest for you, so that you simply and your physician can interact in shared decision-making about your preferences.

See the Harvard Health Birth Control Center for extra data on choices.