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May 14, 2015

Few Women with Heart Disease Counseled on Birth Control Methods

A review of research on this topic finds gaps in care and stresses early education for girls.

Pregnancy is risky for some women living with heart disease, yet few receive proper counseling around birth control options, according to a paper recently published in the European Heart Journal.

Thanks to research and technology, patients with heart conditions are living longer, healthier lives than ever before. That means that more women with sometimes serious heart conditions, like severe congenital heart defects, live well into their childbearing years and may want to become pregnant. Since pregnancy is considered high-risk for at least some women with heart disease, it requires careful planning to reduce risk for complications.

That’s why experts put together everything we know about birth control counseling for women living with heart disease in their recent paper, “Contraception and Cardiovascular Disease.” As authors explain, it’s important that women with heart disease who could become pregnant understand the importance of birth control.

Many women with heart disease take medication that could cause birth defects, such as high blood pressure drugs called ACE inhibitors. Certain types of birth control like those containing estrogen may also increase risk of heart events, which is not ideal for women already living with heart disease.

Unfortunately, studies suggest that more than one-third of women with heart disease receive no counseling at all on contraceptives and another third received poor advice. It’s important that women living with heart disease are well educated on the issue of birth control and have open communication with their doctors, especially if they’re considering pregnancy.

Authors also highlight the importance of early counseling about contraceptives for girls. Research shows that girls are reaching puberty earlier than ever before, often around 12 and 13 years old. Authors encourage counseling girls with existing heart conditions about birth control even before their first period.

When it comes to what type of birth control is best for women with heart disease, authors believe it depends on a number of factors. Of course, it’s important to choose a type of birth control that is both safe and effective for preventing pregnancy. Experts explain that a good approach is to use a highly-effective, long-lasting type of contraception like an intrauterine device combined with a male condom to prevent pregnancy and protect against sexually transmitted diseases.

Patients should also discuss other factors that might impact decisions around birth control, such as cramps, regulation of periods, and even acne. Although these factors may seem less important in the scheme of things, authors explain that they affect the daily comfort of women and should be taken into account during counseling.

Questions for You to Consider

  • How do pregnancy, labor and delivery put extra stress on the heart?

  • During pregnancy, heart rate increases up to 20%, and the heart needs to work 30-50% harder to pump the amount of blood needed for the body and fetus. During labor and delivery, pain, stress and blood loss puts extra stress on the heart, which can lead to heart failure and sudden cardiac death.
  • What are congenital heart defects?
  • Congenital heart defects refer to a number of different conditions that can occur when a baby’s heart is forming or at birth. Although most defects are found during pregnancy or in early childhood, some defects aren’t discovered until adulthood. Survival rates depend on the severity of the heart defect, but most individuals with congenital heart defects live long and healthy lives.

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