When you’re choosing a birth control option, there are a lot of options on the table. But if you have a heart condition, or at higher risk of heart disease, it’s important to know that your choice of contraception can affect your heart health.
Here are four ways that birth control impacts your heart health, and how to go about choosing the right method, according to a cardiologist.
1. Estrogen may need a closer look.
Many people use combination birth control pills that contain estrogen and progestin to control the menstrual cycle.
“Estrogen is the culprit for thrombosis (when blood clots block veins or arteries),” says Katharine Decena, MD, a cardiologist with the Hartford HealthCare Heart & Vascular Institute. “It works by increasing the liver production of factors that increase clotting risk. Therefore, there is a risk of embolism and clotting in different parts of our bodies.”
2. Your existing risk factors may take some birth control options off the table.
For many women taking birth control pills, the health risks (including blot clots) are small.
“However, if you are an older woman, smoke, or already have a family history of coronary disease, adding that estrogen component increases that risk. Alternatively, there are progestin-only contraceptive options or other methods that are generally safer for those patients,” says Dr. Decena.
More on this in a minute.
3. It may increase your blood pressure and cholesterol.
The estrogen/progestin combination birth control pills can increase blood pressure and cholesterol.
Since hypertension and cholesterol are known risks of cardiovascular disease, it’s a good idea to work closely with your doctor, especially if you have heart concerns.
“If you’re on hormone-based birth control or if you’re in hormone therapy, we can closely monitor your blood pressure and blood work and manage it with medications,” explains Dr. Decena. “If we find we can’t manage it, we’ll discuss whether or not this type of contraception is right for you.”
4. Birth control may be necessary to prevent pregnancy-related heart complications.
“In trying to choose an optimal method of contraception for patients, we first consider the risk of pregnancy,” says Dr. Decena. “Because pregnancy itself is already a prothrombotic state, we need to see if any pre-existing conditions may make pregnancy more difficult.”
These conditions may include:
- Existing heart disease
- Severe pulmonary hypertension
- Certain congenital heart diseases
- Low heart muscle function (from prior heart attack or stress-induced cardiomyopathy)
“We weigh all these things and the risk of pregnancy,” says Dr. Decena. “If this will be hard on the body or risky for your health, we’ll work together to find the best plan.”
The options for birth control range from hormonal-based to permanent.
There are many hormone-based birth control options, including:
- Estrogen/progestin combination birth control
- Progestin-only birth control
- Skin patches
- Vaginal ring
There are also non-hormone-based contraception options like barrier methods (i.e., condoms, diaphragms, cervical caps, sponges) and spermicides.
Some people also look to natural family planning, the rhythm method and withdrawal. However, Dr. Decena has an asterisk to consider.
“Natural methods are insufficient, and they have very high failure rates. They are not necessarily the most recommended method, especially if the patient has a high risk of cardiac complications while they are pregnant.”
There are also more permanent options (i.e., tubal ligation, vasectomy) you may want to consider. Don’t forget to include your partner in the birth control discussion, too.
So, which one is best for you?
“As a collective team with your OBGYN and cardiologist, let’s have a collaborative discussion with you,” says Dr. Decena. “We want to hear your preferences, and we’ll also chat about your risk factors before advising or prescribing contraceptives.”
If you have heart concerns, plan (far) ahead for your future family
Birth control isn’t just about today.
Preconception planning is an excellent idea if you have heart concerns, medical issues or you’re just looking ahead.
“If you want to expand your family, we want to help,” says Dr. Decena. “The sooner you verbalize it to your doctors, the better. If you have a timeline, we can plan for pregnancy rather than be surprised. We can modify medications, remove medications, advise you on any risks and work together to optimize your body before you get pregnant.”