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Birth control and congenital heart disease


If you are a woman with congenital heart disease (CHD), choosing safe birth control is an important part of family planning. Most women with mild defects have the same pregnancy risks as women without CHD. Other women may face complex health issues and risks. It is important that all women with CHD discuss contraception and pregnancy with an adult congenital heart disease (ACHD) specialist so they can choose the best options for them.

In Canada, there are 15 adult CHD centres, each within a hospital setting in major cities across Canada. If you are not being seen by an ACHD specialist, speak to your cardiologist or primary healthcare provider about your specific birth control considerations.

 

Work with your healthcare team to figure out what's best for you. Don't be afraid to ask questions.

Contraception considerations

For women who are at risk of health issues due to their CHD, contraceptive choices are based on:

  • pregnancy risk
  • understanding the consequences of an unplanned pregnancy
  • benefits and risks of each method
  • effectiveness of each method
  • health and medical history
  • age
  • individual preference and lifestyle.

Birth control methods
 
  1. hormonal – birth control pills, shots, skin patch, vaginal ring
    · combined estrogen and progesterone
    · progesterone only
  2. IUDs (intrauterine devices)
  3. barrier methods
    · condom
    · diaphragm
    · cervical cap
    · contraceptive sponge
  4. rhythm method
  5. surgical sterilization – a permanent form of contraception
Hormonal birth control

Estrogen-based contraception

This form of birth control might not be the right choice if any of the following apply to you:

  • risk or history of blood clots
  • migraine with aura
  • uncontrolled high blood pressure
  • over 35 years of age, obese and/or a smoker
  • metallic valves
  • poor heart function
  • liver disease
  • cyanosis (bluish colour of skin due to lack of oxygen)
  • heart rhythm problems

Combined hormonal contraceptives

The most common hormonal contraceptives are a combination of the hormones estrogen and progesterone. They can be taken by pill, skin patch, injection or vaginal rings. Estrogens increase the risk for blood clots, so might not be the best choice if you have complex CHD.

Progestin-only contraceptives

Progestin-only birth control pills, such as the mini-pill, are often safe for women with CHD because they have a lower risk of blood clots. But since they have to be taken at the same time EVERY day, they may not be the best choice for preventing a high-risk pregnancy.

Cerazette is a newer progestin-only option. If you miss a dose, you have up to 12 hours to take the missed dose. It is a safer option for women with CHD.

Plan B – or the morning after pill – is an emergency contraceptive if you have had unprotected sex and want to avoid pregnancy. It contains only progestin and the risk of blood clots is low. It is generally safe for women with CHD of any severity.

Injections and implants

An intramuscular injection of progesterone (Depo-Provera) every three months to prevent pregnancy. It is often suitable for women with CHD.

Low-dose progestin implants inserted under the skin of the upper arm provide contraceptive protection for three to five years. They can be easily removed if your family plans change. They are generally safe for women with CHD.

IUD (Intrauterine devices)

An IUD is a long-acting, effective and reversible method of birth control. The IUD is a small, flexible coil that is inserted into your uterus. It releases progesterone to prevent pregnancy for up to five years. Implantation and removal may cause low blood pressure, so you might have to have it implanted in the hospital if you have complex CHD.

Barrier methods

Barrier methods include the condom, diaphragm, cervical cap and contraceptive sponge. Spermicides MUST be used in combination with barrier methods. The risk for women with CHD is the risk of failure and unplanned pregnancy. The failure rate is 15-32% in the first year. Barrier methods are not recommended to prevent high-risk pregnancy.

Rhythm method

In the rhythm method, you track your menstrual cycle to predict when you will be most fertile. During this time you avoid unprotected sex. Its effectiveness depends on how accurate you are at keeping track of your cycle. This form of birth control does not pose any direct risks to the mother or fetus, but it is one of the least effective forms of birth control. The rhythm method is not recommended for preventing high-risk pregnancy.

Permanent sterilization / surgical sterilization

Tubal ligation and tubal implants are two permanent contraception options. The procedure is done under general anesthetic (laparoscopy) so there is some health risk associated for women with CHD. Newer methods are being developed that can be done under sedation. Sterilization is a reasonable option if you know you don’t ever want to have a baby. Vasectomy is an effective method of birth control for men without any risks for women with CHD. It is important for you to talk about how this will affect your partner if you are no longer together.

Key messages
  • Choosing safe birth control is an important part of family planning.
  • All women with CHD should discuss contraception and pregnancy with an adult CHD cardiologist so they understand their risks.
  • Hormonal forms of birth control and implanted devices may not be recommended for some women with CHD because of their individual risk factors.
Related information

More information about birth control from the Adult Congenital Heart Association (US).

To learn more about CHD, check our other webpages.

To find useful services to help you on your journey with heart disease, see our services and resources listing.

This information was written by Shelagh Ross – who lives with congenital heart disease – in collaboration with cardiologists Jack Colman and Lorna Swan of the University Health Network in Toronto.

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