Pregnancy in pulmonary hypertension (PH) can be dangerous for mum and baby. Because of this, contraception is recommended in women of childbearing age with PH. Some forms of contraception are more suitable than others for use in PH. It is important to discuss contraception with your specialist PH team. Don’t avoid the issue – it’s too important.
The combined pill
Combined pills are those that are usually taken for 3 weeks out of every 4. These should be avoided in women with PH, as should other contraceptives containing oestrogen. Oestrogen is a hormone often used in contraceptives, which is thought to make PH worse. It also slightly increases the risk of developing blood clots.
The progesterone-only pill (also known as the minipill) is also not recommended for women with PH. This is because it needs to be taken at the same time every day, so is slightly less effective than the combined pill at preventing pregnancy.
Progesterone can be given by injection (eg Depo-Provera). These injections are normally given every 8 or 12 weeks, depending on which type is used. They are a very reliable method of contraception. Another form of progesterone is an implant, which is placed under the skin. This implant (called Implanon) only needs replacing every 3 years.
Progesterone injections and implants can cause irregular bleeding, although after a year of progesterone injections, most women stop having monthly bleeds, which many see as an advantage.
An intrauterine device (also called a coil) is something that is fitted inside the womb. It is often difficult to fit a coil if you have never been pregnant – sometimes an anaesthetic is needed. Although effective, there is a chance of infection and you may get heavier periods, which may be a problem if you are taking warfarin. All in all, the coil is probably not the ideal method of contraception for women with PH.
There is also a progesterone-releasing intrauterine device, called Mirena. Many women using Mirena get shorter periods, or none at all. Mirena is a very reliable method of contraception, which lasts for up to 5 years.
Male or female sterilisation are permanent methods of contraception. They are an option, but should only be considered after a great deal of careful thought. Male sterilisation (vasectomy) is the most reliable form of contraception. It has a very low failure rate once it has been checked. Female sterilisation involves an operation under a general anaesthetic. This carries a risk for women with PH, especially if you are taking drugs such as warfarin.
Barrier methods such as condoms, caps and diaphragms are less reliable. For this reason, they should always be used with a spermicidal gel.
If you need advice about which contraceptive method is most suitable for you, talk to your PH specialist team.