Contraceptive Methods for Women with Complex CHD
Key findings
- 86% of women with congenital heart disease (CHD) surveyed reported using some type of contraceptive
- Most women with CHD prefer barrier methods or oral contraceptives
- Women with CHD of great complexity reported more thrombosis/thromboembolic events while taking oral contraceptives
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Women with congenital heart disease (CHD) use a variety of contraceptive measures, with barrier methods and oral contraceptives being the two most used. However, despite recommendations against using estrogen-based contraceptives, some high-risk patients commonly used them, according to a study based on a questionnaire given to CHD center patients at Massachusetts General Hospital and a medical records review.
In the United States, more than 90% of children born with CHD now live well into adulthood, even those with the most complex form. This means the number of women with complex CHD is also rising.
Researchers, including Ami B. Bhatt, MD, director of the Adult Congenital Heart Disease Program at Mass General, gave a 48-item questionnaire to 505 women recruited from nine adult CHD centers in North America on their contraceptive practices between 2011 and 2014. Of those women (median age 33), 86% used contraception and 81% had moderate or great complexity CHD.
The methods of contraception they used were barrier methods (87%), oral contraception (84%), intrauterine device (18%), Depo-Provera (13%), vaginal ring (7%), patch (6%), hormonal implant (2%), Plan B (19%) and sterilization (16%), according to the study published in 2016 in the American Journal of Cardiology.
Women with CHD of great complexity reported more thrombosis/thromboembolic events (T/TE) while taking oral contraceptives compared to women with less complex CHD (9% versus 1%, P=0.003). A small number of women (4%) reported using oral contraceptives when T/TE occurred. Diagnoses for these women included bicuspid aortic valve, atrioventricular canal defect, Eisenmenger syndrome, D-transposition of the great arteries and Fontan physiology.
More than half (58%) of the 31 women with Fontan physiology reported currently using oral contraception, while 28% of those women reported experiencing a T/TE while taking oral contraception.
For 38 women with D-transposition of the great arteries, 31 (82%) reported previously using oral contraception, and four of those women reported experiencing a T/TE while doing so. Two patients reported having a lower extremity clot, and two patients reported having had a transient ischemic attack.
Women who had never taken an oral contraceptive reported no history of a T/TE, and the researchers verified that in the medical records.
Women with complex CHD reported using more progestin-only oral contraceptives than the combination of estrogen and progestin contraceptives.
While 84% of women reported receiving contraception counseling, only 43% reported that the counseling came from their adult CHD provider. Fifty-five percent reported counseling from gynecologists, while only 11% reported counseling from a primary care physician.
The researchers cautioned that their results might not be generalizable to a wide population because patients were being cared for in a CHD center, and the study population was mostly Caucasian.
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