It is not true that chronically ill women cannot use contraception. They can, but it must be properly selected not to worsen the general health condition and not to carry additional risks
It is true, however, that hormonal contraceptive pills are contraindicated in some chronically ill women, but not all of them are dangerous. There are ongoing discussions as to whether women with diabetes, cardiovascular, kidney and liver problems can safely protect themselves from unplanned pregnancies. At the same time, the fact is raised that for many chronically ill women, pregnancy and the resulting changes in the body not only carry a risk of deteriorating general health, but sometimes also life-threatening. In addition, the treatment of some chronic diseases is associated with a high risk of having a child with numerous birth defects, which also supports the search for appropriate contraceptive methods. It is also worth remembering that in many cases taking contraceptive pills does not have a major impact on the course of the underlying disease.
Cardiovascular disease
Risk factors for cardiovascular disease in women are smoking, obesity, diabetes, hypertension, increased lipid levels and old age. Some of these, such as obesity, are not in themselves a contraindication to estrogen-containing pills, but when two risk factors such as smoking and obesity are combined, oral contraceptive pills should be avoided.
Combined oral contraception is not used in women with ischemic heart disease or combined valvular disease because in these situations there is an increased risk of embolism, pulmonary hypertension, fluid retention or endocarditis.
But if a woman regularly takes medications that reduce blood clotting, because she has, for example, an artificial valve implanted, she can take hormonal preparations, because the risk of embolism is tolerated by her anticoagulant medications.
Thromboembolism
It is a contraindication to the use of estrogen tablets. This also applies to women who are immobilized due to disability, after surgery or an accident.
Such tablets should also be avoided by women after stroke, with deep vein thrombosis or pulmonary embolism. Estrogens should also not be used in women with a factor V Leiden mutation (a congenital mutant human coagulation factor that promotes thromboembolic changes).
For women at these risk groups, progestogen-only pills may be the contraceptive of choice. It is also possible to use an intrauterine device or barrier methods, e.g. condoms.
Lipid disorders
Standard ethinylestradiol contraceptive pills should not be used by women with lipid disorders, because this estrogen increases LDL cholesterol and reduces HDL levels. Pills with a low dose of progestogen do not have this effect. The tablet of choice will then be the tablet containing natural estradiol, available for two years, because it improves lipid parameters. But estrogens do not harm women who have high cholesterol with normal blood pressure. In women with elevated blood pressure and lipid disorders, the intake of hormonal pills should be monitored by more frequent examination of the lipid profile and blood pressure measurement.
Hypertension
High blood pressure increases the risk of complications with the use of hormonal contraceptives. These women are at risk of stroke (hemorrhagic and ischemic) 3-10 times more often than healthy women.
For women with high blood pressure or vascular changes, preparations containing estrogens are contraindicated. Patients with mild or well-controlled hypertension can use progestogen-only pills and non-hormonal methods (e.g. copper IUD).
Migraines
Women who get migraines with aura are at risk of having a stroke and therefore, regardless of age, should not use the combined pill. Women over 35 years of age with typical migraine headaches (migraine without aura) are also at risk of having a stroke, so they must (if they decide to use hormonal contraception) take them under strict medical supervision.
If migraine headaches or any other type of headache worsen during the use of combined contraceptive pills, the dose of the estrogen or progestogen is reduced or the pills are rejected in favor of another method of contraception. When severe headaches occur during your period, your doctor will usually advise you to continue using the combined pill (monophasic only), the diaphragm or the patch.
Diabetes
Diabetic women want to use contraception until their diabetes is well-controlled, thus reducing the risk of birth defects or miscarriages associated with high glucose levels in early pregnancy. It should be remembered that combined contraceptive pills slightly increase glucose and insulin levels, which, however, most often remain within the normal range.
If a woman, apart from diabetes, has no vascular disease or other cardiovascular burden, and the diabetes does not last more than 20 years, she can use pills containing estrogen, but under close medical supervision. When blood sugar levels rise, tablet-taking should be discontinued.
Women with type 1 or type 2 diabetes may also use an IUD, which is not associated with an increased risk of inflammation of the pelvic organs.
Hormonal contraception is possible in women at risk of gestational diabetes. Even long-term use of low-dose birth control pills does not increase the risk of diabetes. A recommended method is the intrauterine device that releases the local hormone – progestin.
Epilepsy
Women with epilepsy are no more prone to seizures when starting hormonal contraceptives. In fact, the number of attacks may decrease as progestogens raise the seizure threshold. But it must be remembered that some drugs used to treat epilepsy reduce the effectiveness of low-dose birth control pills. The same is true of patches and discs that also contain the progestin ethinylestradiol. But women suffering from epilepsy may be recommended, for example, to use an IUD or a hormone-releasing device, Mirena.
Diseases of the thyroid gland
Despite taking hormones that treat thyroid ailments, there are no limits to using hormonal contraception, barrier contraception, IUD or patches. The areas and mechanisms of action of the hormones taken are different.
Peptic ulcer disease of the stomach and duodenum
In such ailments, contraceptive pills should not be used, because they may aggravate the symptoms resulting from the underlying disease. For this group of women, a contraceptive injection, patch, ring, or Mirena IUD may be a good solution.
Hepatitis B and C
Women who are carriers of the hepatitis C virus should not use birth control pills, which will always be an additional burden on the damaged liver. If a woman has sex, she should use a barrier method of contraception, e.g. condoms, which will additionally protect her partner against transmission of infection.
The situation is slightly different for HBV, which causes hepatitis B infection. If the liver has not been damaged by the virus, hormonal contraception is allowed, but under the strict supervision of a gynecologist and a specialist in liver diseases.
It is also worth knowing that in both cases, pregnancy may be a threat not only for the woman, but also for the child. Therefore, you should use some kind of contraceptive method to protect yourself from an unwanted pregnancy.
In any situation, regardless of the type of chronic disease, you can find a method of contraception that is both effective and safe for a woman. It is not always simple and often requires cooperation between doctors of various specialties, but you can always find some way to enable fertility regulation in women who are not planning or should not become pregnant, not only for personal but also health reasons.
Tekst: Anna Jarosz