From the Guidelines
Oral contraceptives containing estrogen should be avoided in patients with congestive heart failure (CHF) due to the increased risk of thrombosis and fluid retention, and instead, progestin-only methods should be considered as a safer alternative. The use of combined hormonal contraceptives (CHCs) in CHF patients can worsen heart failure symptoms and increase cardiovascular risk 1. For patients with CHF who need contraception, progestin-only methods are preferred alternatives, including the progestin-only pill (POP), depot medroxyprogesterone acetate (DMPA) injections, the etonogestrel implant, or the levonorgestrel intrauterine system (LNG-IUS) 1.
Key Considerations
- The individualized benefits and risks of each contraceptive therapy must be determined based on the patient’s anatomy and physiology in consultation with a gynecologist 1.
- Women with CHD who are at high risk of thrombosis, such as those with cyanosis, Fontan physiology, mechanical valves, prior thrombotic events, and PAH, should avoid estrogen-containing contraception 1.
- The risk of pregnancy is considered greater than the risks linked to contraceptive use, and women with heart failure should discuss contraceptives and planned pregnancy with a physician to take an informed decision based on assessment of potential risks 1.
Recommended Contraceptive Options
- Progestin-only pill (POP) such as norethindrone 0.35 mg daily taken at the same time each day 1.
- Depot medroxyprogesterone acetate (DMPA) injections every 3 months 1.
- The etonogestrel implant which provides contraception for up to 3 years 1.
- The levonorgestrel intrauterine system (LNG-IUS) 1.
However, even with progestin-only methods, patients with severe or decompensated heart failure should have their contraceptive choices carefully evaluated by both a cardiologist and gynecologist to ensure the safest option based on their specific cardiac status, medication regimen, and contraceptive needs 1.
From the Research
Oral Contraceptives and Congestive Heart Failure
- The use of oral contraceptives in patients with congestive heart failure is a complex issue that requires careful consideration of the patient's individual risk factors and medical history 2.
- Women with heart failure may utilize long-acting reversible contraception and permanent sterilization, with modifications made according to the specific etiology of the heart failure 2.
- Hormonal contraceptives, such as combined oral contraceptive pills, can increase the risk of venous thrombosis, which may be a concern for patients with congestive heart failure 3.
- Progestin-only and nonhormonal methods, such as implants and condoms, are associated with rare serious risks and may be a safer option for patients with congestive heart failure 3.
Hormone Treatments and Congestive Heart Failure
- Hormone treatments, such as dual-acting drugs and supplemental treatments with growth hormone or thyroid hormone, are being studied for their potential benefits in patients with congestive heart failure 4.
- The therapeutic effects of progesterone, progestins, and other hormones on the heart are complex and require further study to fully understand their potential benefits and risks in patients with congestive heart failure 5.
Exercise and Congestive Heart Failure
- Exercise training has been shown to improve exercise capacity and reduce symptoms in patients with congestive heart failure, but its impact on left ventricular function, hospital stay, and mortality is not well understood and requires further study 6.
- The effects of exercise training on patients with congestive heart failure are promising, but require confirmation of feasibility, clinical benefit, and safety in larger, long-term randomized trials 6.