From the Guidelines
A history of hypertension and diabetes may disqualify you from using combined oral contraceptive pills (COCs), but it depends on the severity of your conditions, and progestin-only pills (POPs) like Norethindrone 0.35mg daily are generally considered safe alternatives for women with well-controlled hypertension and uncomplicated diabetes.
Key Considerations
- The decision to use oral contraceptive pills (OCPs) in women with a history of hypertension and diabetes should be individualized, taking into account the severity of their conditions and the potential risks and benefits of OCP use 1.
- Combined oral contraceptive pills (COCs) containing estrogen are typically not recommended for women with hypertension or diabetes with complications due to increased risk of cardiovascular events and stroke 1.
- Progestin-only pills (POPs) are generally considered safe alternatives for women with well-controlled hypertension without vascular disease and those with uncomplicated diabetes (no retinopathy, nephropathy, or neuropathy) 1.
Evaluation and Recommendations
Before starting any contraceptive, women with a history of hypertension and diabetes should undergo a thorough evaluation, including:
- Blood pressure measurement
- Assessment of diabetes complications
- Discussion of personal and family history of cardiovascular disease Their healthcare provider might recommend alternative contraceptive methods, such as intrauterine devices, implants, or barrier methods, if their medical conditions make hormonal contraceptives too risky 1.
Pathophysiologic Mechanisms
The estrogen component of COCs is thought to be primarily responsible for blood pressure changes, and the progestin component may enhance the effects of estrogen on blood pressure through off-target effects on the androgen and estrogen receptors 1.
Current Recommendations
Current guidelines recommend that COCs be avoided in individuals with hypertension, although POPs are thought to be safe 1. Expanding access to OCPs through over-the-counter and pharmacist-led prescribing will require standardized guidelines for contraindication screening, including hypertension, that are equitably implemented and distributed 1.
From the FDA Drug Label
Oral contraceptives may compound the effects of well-known risk factors, such as hypertension, diabetes, hyperlipidemias, age and obesity Women with a history of hypertension or hypertension-related diseases, or renal disease should be encouraged to use another method of contraception If women elect to use oral contraceptives, they should be monitored closely and if significant elevation of blood pressure occurs, oral contraceptives should be discontinued. An increased risk of myocardial infarction has been attributed to oral contraceptive use This risk is primarily in smokers or women with other underlying risk factors for coronary artery disease such as hypertension, hypercholesterolemia, morbid obesity, and diabetes.
A history of hypertension and diabetes does not necessarily disqualify someone from using oral contraceptive pills, but it does require caution and close monitoring. The risk of myocardial infarction and stroke is increased in women with these conditions who use oral contraceptives. It is recommended that women with a history of hypertension or hypertension-related diseases be encouraged to use another method of contraception, but if they do choose to use oral contraceptives, they should be monitored closely for significant elevation of blood pressure or other adverse effects 2.
From the Research
History of Hypertension and Diabetes with Oral Contraceptives
- A history of hypertension and diabetes may affect the use of oral contraceptive pills (OCPs), as these conditions can increase the risk of cardiovascular disease and other complications 3.
- Studies have shown that the use of OCPs can lead to an increase in blood pressure, particularly in women with pre-existing hypertension 3.
- However, the risk-to-benefit ratio of using OCPs in women with hypertension and diabetes depends on the severity of the condition and the type of OCP used 3.
Types of Oral Contraceptives
- Different types of OCPs, such as those containing ethinyl estradiol and gestodene, or ethinyl estradiol and chlormadinone, may have varying effects on blood pressure 3.
- Some studies suggest that OCPs containing ethinyl estradiol and chlormadinone or drospirenone may be more suitable for individuals at high risk of developing hypertension 3.
- The use of natural estrogen, such as estradiol, in OCPs may have a better metabolic and vascular profile compared to ethinyl estradiol 4, 5.
Management of Hypertension and Diabetes
- Lifestyle interventions, such as diet and exercise, are crucial in managing hypertension and diabetes 6, 7.
- Pharmacologic treatment of hypertension in diabetes is also important, and certain classes of agents may confer significant benefits in reducing cardiorenal outcomes 6, 7.
- However, the management of hypertension and diabetes in women using OCPs requires careful consideration of the potential risks and benefits 3.