The Effect of Contraceptive Pills on Heart Health

Modern women prefer to plan their pregnancies beforehand, which means that the question of effective contraception is of great importance for many of them. Oral contraceptive medications or simply birth control pills are one of the most popular and widespread methods of protection against unwanted pregnancy. Such method of contraception has its advantages and disadvantages.

Modern contraceptive pills contain the analogues of two major female sex hormones – either both estrogen and progestin (the synthetic form of progesterone) or progestin alone. Today, such pills are used by millions of women all over the world.

Contraceptive pills can be divided into three main groups:

• Combined oral contraceptive pills – these pills are the most commonly used ones; they contain progestins and estrogens and can be monophasic, biphasic or triphasic. Combined contraceptives work by inhibiting ovulation, changing the neck of the uterus so that the sperm can’t enter it because of the thickened cervical mucus, creating “unfriendly” environment for the sperm, affecting the endometrium and making it impossible for the egg to attach to the uterine lining.   
• Mini-pills (progesterone-only pills). These pills are used when estrogens are contraindicated due to some causes, for example, during lactation. Mini-pills thicken the cervical mucus in the uterus and prevent the sperm from fertilizing the egg.
• Emergency contraceptive pills (the morning-after pills). These pills contain a large dose of hormones (progestins, estrogens, or both) and should be taken after unprotected sexual intercourse. Such high doses may prevent pregnancy from happening.

So how do oral contraceptive medications affect the health of the heart? The epidemiologic connection between oral contraceptives (especially those of early generations) and cardiovascular pathology has been proven by numerous studies. The development of heart diseases such as acute myocardial infarction, coronary heart disease, venous thrombosis and cerebrovascular episodes (stroke or subarachnoid hemorrhage) has been reported among major potential complications of such contraceptives. Early studies have shown increased risk of thromboembolic complications (blood clots), heart attack, high blood pressure, and cerebral stroke in women taking contraceptive pills. The effects contraceptive pills produce on the cardiovascular system to a greater extent depend on estrogens contained in these preparations, their dosage and, more importantly, other predisposing factors. The formation of thrombi in the blood vessels happens because combined birth control pills increase the activity of blood coagulation system and affect blood clotting factors. The possibility of such complications is greater in women with the following risk factors – aged 35 and older, smoking, hypertension, diabetes, increased blood lipids, obesity, etc.

However, modern newest-generation combined contraceptives contain lower levels of estrogens (less than 35 mcg); thus, the risk of cardiovascular disorders is lower than in the case of the first-generation pills. But this risk is still very high if a woman who takes contraceptive pills is also a heavy smoker.

The absolute contraindications to taking combined contraceptive pills include:

• Multiple risk factors for cardiovascular disease including hereditary disorders;
• Hypertension;
• Thrombophlebitis, thromboembolic disease, cerebrovascular stroke or myocardial infarction in the past medical history;
• Expected surgical procedures with prolonged immobilization;
• Diagnosed thrombogenic mutations;
• Complicated valvular heart disease;
• Smoking, particularly in women older than 35 years of age.

Doctors recommend that those women who have any of the above-listed contraindications should take into consideration the use of progestin-only options like mini-pills or IUDs.  

It’s important to remember that oral contraceptives perfect for one woman may not be good for another and at different points in her life every woman might need different contraception methods. Taking into account all the available data, only doctor can decide on the most appropriate birth control method. The choice made with due consideration of all individual characteristics and contraindications will help to reduce and avoid possible risks and complications.