Why blood pressure matters when choosing birth control

FOR millions of women, oral contraceptives are an effective way of preventing an unwanted pregnancy, get irregular periods back on track, and even help clear up problems caused by hormonal shifts, such as acne. And for the most part, birth control pills are safe and have only minor potential side effects.

However, decisions about contraception for women with underlying medical problems can be complicated. Certain birth control pills can cause a worrisome increase in blood pressure for some women who take them.  Some people may have only a slight increase and others may have a potentially dangerous increase in blood pressure.

Birth control pills contain one or two hormones: oestrogen and progestin, or just progestin on its own. Although they work to prevent pregnancy, research has shown that these hormones, especially oestrogen, can increase the risk of having high blood pressure.

All contraceptives are safe for healthy women, however, Professor Chris Aimakhu, a consultant obstetric and gynaecologist, University College Hospital (UCH), Ibadan, said women at risk of having high blood pressure are to avoid hormonal contraceptives, especially birth control tablets that contain oestrogen.

“Injectables are safe. And of course, the mini-pills, implants and intrauterine device (IUD) are relatively safe for those with hypertension or those prone to high blood pressure. And of course, condoms don’t affect any blood pressure,” he declared.

The IUD is a little T-shaped device, which goes into the womb and is over 99 per cent effective. The copper IUD lasts up to 10 years and is hormone-free, so it’s safe for someone with high blood pressure. The implant is a tiny matchstick-sized rod that’s inserted into the arm, where it protects from pregnancy for up to three years by releasing a type of progestin (not estrogen). It’s over 99.9 per cent effective.

The mini pill is a progestin-only pill, so it’s safe for anyone with high blood pressure. But unlike combined birth control pills, the mini-pill has to be taken at the same time every day for maximum effectiveness.

Obviously, condoms are oestrogen free, whether it is the male condom or the female ones.  Also, they’re the only contraception that also protect against sexually transmitted infections.

Professor Aimakhu declared that there is a possibility of a blood clot in a leg (deep vein thrombosis, or DVT) or a blood clot in a lung (pulmonary embolism, or PE) occurring is high in such women who take birth control pills with oestrogen content.

But blood clots can cause serious health problems. A blood clot in a leg vein can travel through the vessels moving blood up from the legs to the lungs and cause a pulmonary embolism. This can be deadly because it can stop blood from getting to the lungs.

He declared that the potential of blood clot is further increased in these women when they are older than 35, obese, and/or smoke.

Moreover, the likelihood that a combined birth control pill use will increase blood pressure also with a history of high blood pressure when pregnant, a family history of high blood pressure (especially in female relatives) and a history of heart problems or blood vessel issues.

Professor Aimakhu, however, added that combined birth control pill should also be avoided by women that have a predisposition to malignancies such as breast cancer because of the high level of oestrogen in those pills.

Besides, Mrs Stella Akinso, a nurse/midwife and Oyo team lead, Sustaining Programmes and Partnerships in Reproductive Health Transformation (SUPPoRT) initiative, said that to ensure a woman takes a safe and effective method, proper counselling and a thorough personal and family medical history is taken while also considering the medical eligibility criteria for each of the contraception.

Mrs Akinso stated that the medical eligibility criteria for each of the contraception is a guideline developed by the World Health organisation and is a global standard. It specifies what contraceptive is suitable for a client that has  a particular ailment or disease or health condition.

According to her, at the family planning clinic, women coming for a family planning method is expected to be told available family planning methods, how they work, side effects associated with each of the methods and how women can cope with these side effects.

Although a family planning provider is not to choose for the client, but allow the client to pick what she wants, Mrs Akinso, said through counselling, adequate present and past medical history is taken and the WHO’s medical eligibility criteria for each of the contraception, she would be helped to still choose the method that is safe and effective.

Basically, the risk of high blood pressure increases with the age. When women stop taking the combined birth pill, their blood pressure usually becomes lower. But some research says that birth control pills may cause a small (yet significant) increase in diastolic pressure—and this can continue in older women who have been off the pill for years.

So, before commencing  a birth pill, it is important to ensure it is confirmed to be safe at the family planning clinic. It is very important to also be honest with the family and medical history. In addition, blood pressure needs to be checked regularly in women who are taking  combined contraceptive pills.



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