If you are a woman with congenital heart disease (CHD), choosing safe birth control is an important part of family planning. Some 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 in collaboration with obstetrics and gynecology experts so they can choose the best options for them.
In Canada, there are 16 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.
Reproductive health 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
- hormonal – birth control pills, shots, skin patch, vaginal ring
· combined estrogen and progesterone
· progesterone only - IUDs (intrauterine devices)
- barrier methods
· condom
· diaphragm
· cervical cap
· contraceptive sponge - fertility awareness based methods
· calendar
· LH (luteinizing hormone) strips
· body temperature
· cervical mucus
· withdrawal - surgical sterilization – a permanent form of contraception
1. 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
- are 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 are often safer for women with CHD because they have a lower risk of blood clots. This pill may be less effective than combined estrogen and progesterone pills and may need to be used in combination with another type of contraceptive method. For women with CHD, it is important to consult your healthcare team before use.
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. For women with CHD, it is important to consult your healthcare team before use.
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 safer for women with CHD. This type of device may carry an increased risk for infection after implantation. Women with CHD should discuss the need for antibiotics to help prevent infection with their healthcare team before use.
2. 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. An IUD may carry an increased risk for infection in the first several months after implantation. Women with CHD should discuss the need for antibiotics to help prevent infection with their healthcare team before use.
3. 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 pregnancy in high-risk cases.
4. Fertility awareness based methods
With fertility awareness, you learn how to interpret your body’s natural signs and symptoms like changes in cervical mucus and basal body temperature to identify your fertile window (the days when you are most likely to become pregnant). During this time, you avoid unprotected sex. This form of birth control is non-hormonal and does not pose any direct risks to the mother or fetus, however, its effectiveness depends on the cooperation of users (partners in a sexual relationship). It’s highly recommended that you work with a trained practitioner to ensure support, knowledge and efficacy.
5. 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 may have to be considered and should be based on discussions with your healthcare team. .
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 a healthcare professional with expertise in pregnancy for women with CHD.
- 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.
- Heart valve disease
- Heart valve surgery
- CHD transition
- CHD: Working with healthcare providers
- Pregnancy and CHD
- CHD: What to watch for
This information is an updated version of a previous article written by Shelagh Ross – who lives with congenital heart disease – in collaboration with cardiologists Jack Colman and Lorna Swan, ACHD program, Peter Munk Cardiac Centre and University of Toronto.
