Is it safe to use injectable hormonal contraceptives, such as Medroxyprogesterone acetate (DMPA), in individuals with mildly elevated blood pressure, specifically a reading of 143/89, which indicates stage 1 hypertension?

Injectable Hormonal Contraceptives in Patients with Blood Pressure 143/89

Injectable progestin-only contraceptives like Medroxyprogesterone acetate (DMPA) can be safely administered to individuals with a blood pressure of 143/89 mmHg (stage 1 hypertension). 1, 2

Blood Pressure Considerations for Hormonal Contraception

• Blood pressure should be measured before initiating any hormonal contraceptive method, as this is classified as an essential examination (Class A) 3
• Patients with blood pressure 140-159/90-99 mmHg (stage 1 hypertension) generally should not use combined hormonal contraceptives (U.S. MEC 3) 3
• Patients with more severe hypertension (≥160/100 mmHg) or vascular disease should not use combined hormonal contraceptives (U.S. MEC 4) 3
• Progestin-only contraceptives, including injectable forms like DMPA, are considered safe for women with hypertension as long as it is well controlled and monitored 2, 4

Evidence Supporting Injectable Progestin-Only Contraceptives in Hypertension

• Research has shown that medroxyprogesterone acetate (DMPA) does not raise blood pressure and may actually decrease it slightly in some patients 1
• Studies consistently report no significant association between high blood pressure and progestin-only contraceptive use for up to 2-3 years of follow-up 2
• Progestin-only contraceptives are considered safe with respect to hypertension risk, unlike combined hormonal methods 4
• Injectable contraceptives have shown variable effects on blood pressure in different studies, but the clinical significance is minimal in controlled hypertension 5

Practical Recommendations for Administration

• No additional examinations or tests are needed before initiation of DMPA in otherwise healthy women with controlled hypertension 3
• Blood pressure monitoring should continue after initiation of DMPA to ensure it remains controlled 3
• DMPA can be started at any time if it is reasonably certain the woman is not pregnant 3
• If starting DMPA more than 7 days after the start of menstrual bleeding, advise using additional contraceptive protection for the next 7 days 3

Alternative Contraceptive Options

• For patients with hypertension, other progestin-only options include:

  • Progestin-only pills 2, 4
  • Levonorgestrel intrauterine devices (may actually reduce blood pressure) 5
  • Subdermal implants 3

• Barrier methods and copper IUDs are also excellent non-hormonal options for patients with hypertension 3

Monitoring and Follow-Up

• Regular blood pressure monitoring is recommended for all patients using hormonal contraceptives 3
• Patients should be informed about potential bleeding irregularities with DMPA use, including amenorrhea and unscheduled spotting 3
• DMPA injections should be repeated every 13 weeks, with a grace period of up to 15 weeks from the last injection 3

Caution and Contraindications

• If the patient has additional cardiovascular risk factors (smoking, diabetes, hyperlipidemia), a more thorough risk assessment is warranted 3
• If the patient has a history of vascular disease or severe uncontrolled hypertension (≥160/100 mmHg), alternative non-hormonal methods should be considered 3