section name header

Information

Editors

LeeaKeski-Nisula

Contraception in Patients with Systemic Diseases

Cardiovascular diseases

Valvular diseases (including significant mitral valve prolapse); previous myocardial or cerebral infarction

  • Subcutaneous progestogen implants and progestogen pills are options, as well as hormonal and copper IUDs (if in a stable sexual partnership and with no increased susceptibility to infections).
  • Combined oral contraceptives (COCs) are not recommended because of the increased risks of thromboembolism.

Chronic hypertension

  • Copper or hormonal IUDs, or progestogen-only pills or implants can be recommended.
  • COCs are absolutely contraindicated if the disease is in poorly controled.
  • Preparations containing drospirenone are considered to have a favourable effect on blood pressure.
  • There are only few studies performed in hypertensive patients.

Thromboembolic diseases

  • COCs are contraindicated.
  • Further tests (laboratory tests of haemostasis) are indicated before prescribing such products in cases with a strong family history of thromboembolism, even without previous thromboembolic complication in the patient herself Evaluation of Thrombophilia
  • IUD is the preferable mode of contraception.

Metabolic diseases

Diabetes Hormonal Versus Non-Hormonal Contraceptives in Women with Diabetes Mellitus Type 1 and 2

  • COCs may impair the response to insulin. Therefore, it is important to check glycaemic control after beginning to take a COC.
  • Low-oestrogen COCs are safe in young, nulliparous women (spotting may be a sign of insufficient hormone contents); IUDs are also possible alternatives.
  • COCs are contraindicated in patients with organ damage.
  • Copper IUDs, hormone-releasing IUDs and progestogen implants are suitable alternatives and for older women also sterilization.

Dyslipidaemia

  • Progestogen products and IUDs are suitable.
  • COCs are not the first choice as they considerably increase the risk of thrombosis.

Polycystic ovarian syndrome (PCOS)

Serious liver diseases

  • IUDs and barrier methods are suitable.

Thyroid disorders

  • No impact on the selection of contraceptive methods

Neurological diseases

Migraine and headaches

  • COCs worsen the symptoms of migraine in one in three patients. An IUD or progestin-only contraceptive methods is an alternative in such cases.
  • Because of the possibly increased risk of thrombosis, COCs are contraindicated for women of any age who have migraine with aura and for women over 35 years of age who have migraine without auraRisk of Ischaemic Stroke in People with Migraine with Aura.
  • If headaches become worse during the use of a COC, it should be withdrawn.

Epilepsy

  • A copper IUD or hormone-releasing IUD are the first-line choices.
  • Phenobarbital, phenytoin, carbamazepine, lamotrigine, primidone and paramethadione induce steroid-metabolizing enzymes, possibly lowering hormone levels and thus increasing the risk of pregnancy in women using hormonal contraception.
  • Benzodiazepines or valproate are not associated with such an effect and can therefore be combined with COCs.

Psychosis, drug addiction

  • As long-term methods, copper and hormone-releasing IUDs, as well as progestogen implants are preferred.
  • According to some studies, COCs have been associated with an increased tendency to depression but the association is weak and high-quality studies are needed.

Other diseases

Rheumatic diseases and other autoimmune diseases

  • All contraceptive products can be used by patients with rheumatoid arthritis.
  • IUDs and contraceptive implants are recommended for patients with SLE or the antiphospholipid syndrome.
  • In patients with MS with restricted movement, COCs should be avoided (risk of thrombosis) and IUDs preferred.

Obesity

  • Copper IUDs and progestogen-releasing IUDs can be used.
  • It has been suggested that body weight over 85-90 kg and/or BMI over 30-35 kg/m2 decreases the efficacy of COCs. Evidence from prospective studies is, however, still lacking Hormonal Contraception in Overweight or Obese Women.
  • Overweight is also associated with the risk of hypertension and hence an increase in the risk of thrombosis.

Cancer

  • COCs are believed to increase the risk of recurrence of hormone-dependent breast cancer or promote the spread of the disease.
  • A history of breast cancer is a contraindication for hormonal contraception. A copper IUD is the preferable mode of contraception.
  • In most other types of cancer, there is insufficient data available on restrictions or recommendations related to the use of hormonal contraception.
  • If postcoital contraception is needed for a woman with hormone-dependent cancer, a copper IUD is recommended.

Renal diseases

  • Hypertension associated with renal disease may affect the choice of contraceptive method.

Asthma

  • No impact on the choice of contraceptive method

    References

    • Bonnema RA, McNamara MC, Spencer AL. Contraception choices in women with underlying medical conditions. Am Fam Physician 2010;82(6):621-8. [PubMed]
    • Curtis KM, Chrisman CE, Peterson HB, WHO Programme for Mapping Best Practices in Reproductive Health. Contraception for women in selected circumstances. Obstet Gynecol 2002 Jun;99(6):1100-12. [PubMed]
    • Pitts SA, Emans SJ. Controversies in contraception. Curr Opin Pediatr 2008 Aug;20(4):383-9. [PubMed]
    • O'Brien SH, Koch T, Vesely SK et al. Hormonal Contraception and Risk of Thromboembolism in Women With Diabetes. Diabetes Care 2017;40(2):233-238. [PubMed]
    • Houtchens MK, Zapata LB, Curtis KM et al. Contraception for women with multiple sclerosis: Guidance for healthcare providers. Mult Scler 2017;23(6):757-764. [PubMed]
    • Dragoman M, Curtis KM, Gaffield ME. Combined hormonal contraceptive use among women with known dyslipidemias: a systematic review of critical safety outcomes. Contraception 2016;94(3):280-7. [PubMed]
    • Lopez LM, Bernholc A, Chen M et al. Hormonal contraceptives for contraception in overweight or obese women. Cochrane Database Syst Rev 2016;(8):CD008452. [PubMed]
    • Skovlund CW, Mørch LS, Kessing LV et al. Association of Hormonal Contraception With Depression. JAMA Psychiatry 2016;73(11):1154-1162. [PubMed]
    • Gaffield ME, Culwell KR, Lee CR. The use of hormonal contraception among women taking anticonvulsant therapy. Contraception 2011;83(1):16-29. [PubMed]
    • Gensous N, Doassans-Comby L, Lazaro E et al. [Systemic lupus erythematosus and contraception: A systematic literature review]. Rev Med Interne 2017;38(6):358-367. [PubMed]
    • Pragout D, Laurence V, Baffet H et al. [Contraception and cancer: CNGOF Contraception Guidelines]. Gynecol Obstet Fertil Senol 2018;46(12):834-844. [PubMed]
    • Gompel A, Ramirez I, Bitzer J et al. Contraception in cancer survivors - an expert review Part I. Breast and gynaecological cancers. Eur J Contracept Reprod Health Care 2019;24(3):167-174. [PubMed]