Contraception and your congenital heart disease

If you have a heart problem, it’s important that you discuss fertility, pregnancy and contraception with a specialist. As well as being able to tell you how your condition can affect the contraceptive you take, they can advise you what methods are most suited to you. Talking things through could also help you avoid having to deal with an unexpected pregnancy.

Pregnancy risks

Lots of women who have congenital heart disease have successful pregnancies, but the strain of pregnancy on the heart can lead to problems and make your pregnancy high risk. If you are high risk, you'll need the most effective contraception available to you to prevent accidental pregnancy. If you’re lower risk, you may have more contraceptive options but they are likely to have a higher failure rate.

Contraceptive methods

Natural

If you’re aware of your cycle and when your periods, you can learn at which times during the month you're most likely to get pregnant in order to avoid it. This is called the natural method. As a contraception, this isn’t very reliable and really depends on how carefully you use it.

Side effects

This method doesn’t have any side-effects but if it’s really important for you to avoid pregnancy, this method isn’t for you.

Barrier (condoms and diaphragm)

Although condoms have the benefit of protecting you against sexually transmitted diseases, when it comes to pregnancy prevention, they have fairly high failure rates - even when used with spermicidal creams. 

Side effects

Condoms and diaphragm have few side effects

Coil

Picture of the coil, contraceptive deviceThe coil is also known as an intrauterine contraceptive devices – IUCD. 

The risk of pregnancy using the Mirena coil is extremely low, even lower than it would be after sterilisation, and they are effective for up to five years.

Side effects

Approximately one in a thousand women have a fainting reaction when their coil is inserted. This can be dangerous for women with severe heart disease, especially if there are no experts available to help. If you do have a severe heart condition and want a coil fitted, although a fainting reaction is rare, it should be fitted in hospital with a cardiac anaesthetic expert present. An actual anaesthetic is not usually necessary.

Another rare complication of coils is that if you get pregnant, it can occur in the fallopian tube. This is known as an ectopic pregnancy and these usually have to be removed surgically.

Oral contraceptive pills

There are two main types: one containing both oestrogen and progestogen hormones (the combined pill), the other containing only low doses of progestogen (the low-dose or mini pill).

The combined pill

This is still probably the most effective, with failure rates of only 1 in 300 women getting pregnant each year, if taken correctly. The combined pill has many advantages, especially regulating the periods. The combined pill is also available as a patch or vaginal ring.

Side effects

The most important complication of the combined pill is that it can increase the risk of blood clotting, or thrombosis, up to three or four times. However, this is still only about half the risk for the average woman of dying because of her pregnancy. Certain heart conditions are associated with an increased risk of clotting and therefore you may be told that this form of contraception is not suitable for you.

Low dose (progestogen-only pill (POP)

By contrast, the traditional POP pill (for example, micronor) has a higher failure rate than the combined pill, which is why it is now being replaced by new version. Cerazette® (desogestrel), is a new, low dose pill which stops ovulation and provides a longer timeframe or you to remember to take it. This means that the occasional missed pill is less likely to result in pregnancy. Cerazette® is related to the drug in Implanon® and can be used as a test before the implant is inserted.

Side effects

The low dose pill has almost no dangerous side effects, although about one in five women discontinue because of irregular bleeding.

Hormone injection

Depo-Provera® is a progestogen-only injection of hormone. These intra-muscular injections of progestogen last for 12 weeks and often cause your periods to disappear, although they may become heavy or irregular when you decide to stop. The periods will often disappear, although they may be irregular or heavy for a while. 

The failure rate for this is low – only 1 pregnancy in 300 women per year, but this may not be a good option if you are on warfarin or have a needle phobia.

Progestogen implant

This is a small implant which is inserted under the skin in the upper arm by a doctor or nurse. It delivers a continuous dose of the hormone, etonogestrel, and in  20% of women causes their to periods stop completely. Picture of the contraceptive hormone implant

Implanon is one of the safest and most effective forms of contraception available and can last up to three years. The risk of getting pregnant is very low – less than 1 in 1000 per year.

Nexplanon has now replaced Implanon, which was sometimes difficult to insert correctly.

Side effects

The drug, bosentan, sometimes used for heart disease, can reduce the effectiveness of most hormonal contraception, including Cerazette and Nexplanon, so additional contraception should be used if you need to take bosentan.

Sterilisation

Sterilisation may be an option for you if you and your partner decide that you don’t want to get pregnant at any point. A man can have a vasectomy and a woman can be sterilised, although a vasectomy is more reliable, and safer.

Safest sterilisation for women with heart problems

For women, sterilisation is done using clips applied to the tubes, either through the keyhole method (laparoscopic) under anaesthetic, or a mini laparotomy which involves surgery rather than a keyhole incision. A laparotomy is also done under regional anaesthetic (not asleep), which may be safer for some women with heart problems. A laparoscopy involves putting gas at high pressure into the abdomen so the womb and tubes can be visualised, which can sometimes affect the heart.

Once the clips have been put in place, the risk of getting pregnant is only about 1 in 500 – pregnancy can occur if the clip doesn’t close the tube. The tubes can be cut and tied at caesarean section, but then the risk of the tubes joining up again is greater, around 1 in 200.

Latest sterilisation techniques

A new technique involves putting small implants into the fallopian tubes to block them. This is done via a hystereoscope, a thin tube used to look inside the womb via the vagina. This procedure can be done under local anaesthetic, or intravenous sedation, although it should always be done in a centre fully equipped to deal with women with heart problems. This is called essure, and is not widely available yet, so your doctor should advise you where it can be done.

Emergency contraception

Coil

The copper IUCD (coil) is the most effective method of emergency contraception and will prevent over 99% of pregnancies. It can sometimes be used later than five days after sex, if it is likely to be no more than 5 days since you released an egg (ovulated). You may also be offered an antibiotic to prevent pelvic infection. You can choose to keep using the IUCD for contraception or it can be easily removed when your next period comes.

Morning-after pill

Oral emergency contraception, or the morning after pill, can be used up to five days after sex, although, the sooner you take it, the more effective it’s likely to be. There are two types of pill available:

Progestestogen hormone (levonorgestrel)

You can either buy Levonelle® or get it free from. Levonelle can be used up to 72- hours after sex. It consists of one tablet which you should take as soon as possible.
Side effects: Taking Levonelle may upset warfarin control, and we wouldn’t advise you to take it if you have a rare condition called porphyria (nothing to do with heart disease).

Ulipristal acetate (ellaOne®)

This can be taken up to five days (120 hours), after sex and is available on prescription from your local doctor or sexual health clinic. It should not be used by women with severe asthma or liver disease.

Side effects

The side effects of emergency oral contraceptive pills are mild (nausea, breast tenderness, disruption to periods) and there are no long-term effects. Levonelle and ellaOne can also be affected by some medications.

Other sources of information

Find out more about family planning clinics and family doctors:

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