There are three effective forms of contraception that contain the hormone estrogen: the contraceptive patch, combined hormonal birth control pills and a vaginal ring. Doctors have usually recommended that women avoid using estrogen contraception if they have high blood pressure. Current US guidelines define a systolic pressure of 130 mm Hg and a diastolic pressure of 80 mm Hg or higher. A current clinical update in JAMA clarifies whether it is safe for some women with high blood pressure to use these forms of contraception.
Why is blood pressure important when choosing birth control?
Contraception that contains estrogen can increase blood pressure. If women with high blood pressure use these contraception methods, there is an increased risk of stroke and heart attack compared to women without high blood pressure. However, your actual chances of having a stroke or heart attack are still quite slim.
When considering contraceptive options, it is important to also weigh the possible risks of unwanted pregnancy. A woman with a history of high blood pressure before becoming pregnant is more likely to have it
- Preeclampsia, a pregnancy complication that can affect liver and kidney function and even lead to eclampsia or seizures
- Diabetes during pregnancy
- Blood clots
- Heart attack
She is also at greater risk of fetal growth and premature birth problems.
Why are blood pressure and birth control recommendations being updated?
When US blood pressure guidelines changed in 2017, many more people were diagnosed with high blood pressure. This happened because the new guidelines tightened the standards as follows:
- Normal blood pressure is less than 120 (systolic) / 80 (diastolic) mm Hg
- increased blood pressure is between 120 and 129 mm Hg (systolic) and below 80 mm Hg (diastolic)
- High blood pressure is 130 mm Hg (systolic) and 80 mm Hg (diastolic) or higher.
With these updated definitions, nearly half of American adults have high blood pressure. Black women are particularly at risk: more than half of black women over 19 are diagnosed with high blood pressure.
If a woman has high blood pressure, that is JAMA update recommends weighing three factors before starting estrogen-based contraception: a woman’s age, blood pressure control and other risks for heart disease.
- Safe to use estrogen-based contraception: When women are 35 years of age or younger, have well-controlled blood pressure, and are healthy, estrogen-based birth control may be used. Have your blood pressure checked by a doctor within one month of starting this type of birth control. In addition, routine blood pressure checks are recommended twice a year.
- Should Avoid Estrogen Contraception: Estrogen-based birth control should be avoided if women are older than 35, even if they have well-controlled blood pressure. Similarly, women of all ages who have multiple risk factors for heart disease or who have uncontrolled high blood pressure should not use estrogen-based birth control. These women should also not use the birth control pill (Depo-Provera), as it can raise cholesterol and, according to the review, lead to an increased risk of stroke. (This medication contains another hormone called progestin.)
The JAMA Updated the reviewed evidence based on an older definition of high blood pressure associated with birth control. More research is needed to better understand how different blood pressure ranges can affect women using estrogen-based birth control. However, it is unlikely that these recommendations will change further due to the newer definition of high blood pressure.
Which birth control methods do not contain estrogen?
What can women who cannot use estrogen-based birth control use to prevent pregnancy? The good news is that there are a variety of other methods of birth control, both hormonal and non-hormonal.
- The most reliable forms of contraception without estrogen are the copper intrauterine device (IUD), the hormonal IUD, the implant and sterilization for women or men.
- Non-hormonal methods include the copper IUD, male or female condoms, the cervical cap, and the diaphragm.
- Three only progestin-hormone methods are safe to use: the minipill, the contraceptive implant, or the hormonal IUD. However, contraception (Depo-Provera) is not recommended for women who have high blood pressure.
When you have high blood pressure, exercise and dietary changes remain important parts of maintaining your heart health. Discuss with your doctor which birth control options are best for you so that you and your doctor can jointly decide your preferences.
See the Harvard Health Birth Control More information about options.