Is Nexplanon (etonogestrel) safe for a 44-year-old woman with hypertension?

Nexplanon Safety for a 44-Year-Old Woman with Hypertension

Nexplanon (etonogestrel implant) is generally safe for a 44-year-old woman with hypertension, provided her blood pressure is well-controlled and monitored regularly. 1, 2

Safety Profile of Progestin-Only Contraceptives in Hypertension

• Progestin-only contraceptives like Nexplanon are recommended as the first-line hormonal option for women with hypertension 1
• Unlike combined hormonal contraceptives, progestin-only methods have not shown significant association with increased blood pressure in studies with up to 2-3 years of follow-up 2
• Nexplanon exerts its contraceptive effects primarily by suppressing ovulation and is the most effective method of long-acting reversible contraception 3

Contraindications and Precautions

• Combined hormonal contraceptives (containing estrogen) are contraindicated in women with hypertension, even if well-controlled 1, 4
• Nexplanon (etonogestrel implant) does not contain estrogen, making it a safer option for women with hypertension 1, 2
• The FDA label for etonogestrel specifically states that combined hormonal contraceptives are contraindicated in women with uncontrolled hypertension or hypertension with vascular disease, but does not list this contraindication for progestin-only methods like Nexplanon 4

Monitoring Recommendations

• Blood pressure should be checked at least every 6 months for women using any hormonal contraceptive method 1
• Baseline cardiovascular risk assessment should be performed before initiating Nexplanon, including evaluation for additional risk factors (age >35 years, smoking, obesity, family history of hypertension) 1
• At age 44, the patient is approaching perimenopause, which may be an additional consideration for contraceptive choice 5

Benefits vs. Risks

• Benefits of Nexplanon include:

  • High efficacy (>99%) in preventing pregnancy 3
  • No need for daily compliance 3
  • Rapid return to fertility after removal 3
  • No estrogen-related cardiovascular risks 1, 2

• Potential side effects to be aware of:

  • Changes in menstrual bleeding patterns (most common adverse reaction) 3
  • Potential for implant site reactions 4
  • Rare cases of hypersensitivity reactions 4

Special Considerations for Perimenopausal Women with Hypertension

• For women approaching menopause (like this 44-year-old), progestin-only methods provide effective contraception without the cardiovascular risks associated with estrogen 1
• Nexplanon should be removed by the end of the third year of use 3
• Regular monitoring of blood pressure is essential, especially in women with pre-existing hypertension 1

Common Pitfalls to Avoid

• Avoid prescribing combined hormonal contraceptives (pills, patches, rings) which contain estrogen, as these can increase blood pressure and cardiovascular risk 5, 1
• Don't assume all hormonal contraceptives carry the same risk profile - progestin-only methods like Nexplanon have a more favorable cardiovascular profile 1, 2
• Be aware that some antihypertensive medications may have interactions with hormonal contraceptives, though this is more common with combined methods than with progestin-only options 1

In conclusion, Nexplanon is an appropriate and safe contraceptive choice for a 44-year-old woman with hypertension, provided her blood pressure is well-controlled and regularly monitored.