From the Guidelines
Hormonal birth control options should be avoided in someone in perimenopause with heart block due to the increased risk of cardiovascular complications, and instead, non-hormonal methods such as copper IUDs or barrier methods should be considered. When evaluating contraceptive options for a woman in perimenopause with heart block, it is crucial to consider the potential risks and benefits of each method. According to the European Society of Cardiology guidelines 1, combined hormonal contraceptives containing estrogen are not recommended for women with significant cardiac conditions, including heart block, as estrogen can increase cardiovascular risks.
Key Considerations
- The specific type and severity of heart block play a significant role in determining the safest contraceptive options.
- Perimenopause is a transitional phase where fertility decreases, but pregnancy remains possible, making contraception still necessary while potentially complicating hormonal management.
- A thorough evaluation by both a cardiologist and gynecologist is essential to determine the safest contraceptive approach based on the specific cardiac condition, perimenopausal symptoms, and individual risk factors.
Contraceptive Options
- Non-hormonal methods like copper IUDs or barrier methods (condoms, diaphragms) are generally safer options for women with cardiac conditions.
- Progestin-only methods, such as the mini-pill, implants, or hormonal IUDs, may be appropriate for some patients with heart block, but require individual assessment, as noted in the guidelines 1.
- The levonorgestrel-releasing intrauterine device is a safe and effective contraceptive option for women with certain cardiac conditions, but its use in women with heart block should be carefully considered, taking into account the potential risks and benefits, as outlined in the guidelines 1.
From the Research
Considerations for Birth Control in Perimenopausal Women with Heart Block
- The decision to give birth control to someone in perimenopause who has heart block should be made with caution, considering the potential risks and benefits of hormone therapy (HT) in this population 2, 3.
- Studies have shown that HT can increase the risk of cardiovascular events, such as coronary heart disease, venous thromboembolism, and stroke, particularly in women with pre-existing cardiovascular disease or risk factors 2, 4.
- The risk of cardiovascular disease is already increased in perimenopausal women due to the loss of ovarian hormones, which can lead to adverse changes in lipids, lipoproteins, and blood pressure 5.
- However, some studies suggest that certain types of HT, such as drospirenone/17beta-estradiol, may have beneficial effects on blood pressure and cardiovascular risk profile in postmenopausal women 4.
- It is essential to weigh the benefits of symptom relief against the potential risks of HT in perimenopausal women with heart block, and to consider alternative treatment options for managing menopausal symptoms 2.
- Regular exercise, such as low-moderate intensity aerobic exercise, resistance exercise, or mind-body exercise, may also have positive effects on heart rate variability and cardiovascular health in perimenopausal and postmenopausal women 6.
Key Factors to Consider
- The presence of heart block and other cardiovascular risk factors
- The type and dose of HT or birth control being considered
- The individual's overall health status and medical history
- The potential benefits and risks of HT or birth control in perimenopausal women with heart block
- Alternative treatment options for managing menopausal symptoms and cardiovascular risk factors 2, 3, 5, 4, 6