Contraceptive Hormone Use and Cardiovascular Disease

Abstract

Contraceptive hormones, most commonly prescribed as oral contraceptives (OC), are a widely utilized method to prevent ovulation, implantation and therefore pregnancy. The Women’s Health Initiative demonstrated cardiovascular risk linked to menopausal hormone therapy among women without pre-existing cardiovascular disease, prompting review of the safety, efficacy and side effects of other forms of hormone therapy. A variety of basic science, animal and human data suggest that contraceptive hormones have anti-atheromatous effects, however relatively less is known regarding the impact on atherosclerosis, thrombosis, vasomotion and arrhythmogenesis. Newer generation OC formulations currently in use indicate no increased myocardial infarction (MI) risk for current users, but a persistent increased risk of venous thrombo-embolism (VTE). There are no cardiovascular data available for the newest generation contraceptive hormone formulations, including those that contain newer progestins that lower blood pressure, as well as the non-oral routes (topical and vaginal). Current guidelines indicate that, as with all medication, contraceptive hormones should be selected and initiated by weighing risks and benefits for the individual patient. Women 35 years and older should be assessed for cardiovascular risk factors including hypertension, smoking, diabetes, nephropathy and other vascular diseases including migraines, prior to use. Existing data are mixed with regard to possible protection from OC for atherosclerosis and cardiovascular events; longer-term cardiovascular follow-up of menopausal women with regard to prior OC use, including subgroup information regarding adequacy of ovulatory cycling, the presence of hyperandrogenic conditions, and the presence of prothrombotic genetic disorders is needed to address this important issue.

A long-term follow-up study of mortality in transsexuals receiving treatment with cross-sex hormones

“…Recently, raised levels of circulatory inflammatory markers in transsexuals treated with high dose of oral estrogens have been reported, which could further contribute to the increased cardiovascular risk (10). An increased risk of cardiovascular disease was also reported in women using oral contraceptives (OC), in particular if they used OC pills with a higher ethinyl estradiol content (50 mg), even more so when they were smokers (21)(22)(23). The increased risk, however, disappeared after discontinuing OC use (24).…”

Dyslipidaemia, combined oral contraceptives use and their interaction on the risk of hypertension in Chinese women

“…Therefore, measurement of lipid should be recommended in women with dyslipidaemia before COC use. 34 COC users should get their blood pressure levels checked regularly during the period when they are using COC and that the onset of hypertension is a reason to stop using COC or consider other forms of contraception. 35 Dyslipidaemia, COC use and their interaction on hypertension W Wei et al…”

Wytyczne ESH/ESC dotyczące postępowania w nadciśnieniu tętniczym w 2013 roku

“…Aktualne wytyczne wskazują, że doustną antykoncepcję trzeba wybierać i rozpoczynać po indywidualnym rozważeniu ryzyka i korzyści u danej pacjentki [491]. Powinno się kontrolować BP za pomocą właściwie dokonywanych pomiarów, a pojedynczy odczyt wartości BP nie powinien służyć do rozpoznania nadciśnienia tętniczego [492].…”