Hypertension and Hormonal ContraceptionPosted on Jun 25,2017
The choice of contraception method should be the woman’s choice. The health care organization that provides contraceptive options for women should involve them in the conversation about what is the best for them. Full information should be available to the woman about the pros and cons of each of each contraceptive option including the effect on her future pregnancy and her present diseases such as hypertension.
Impact of contraceptive hormones on hypertension
The recent use of hormones for contraception is the favorable choice for many women around the world. The woman can get pregnant once she stops taking the hormone-based contraception. The on-and-off effect of the hormone contraceptive is the attractive issue. Estrogen hormone (ethinylestradiol as usual) and progestogen hormone or progestogen alone are commonly used for the purpose of contraception. The woman can be administered the hormone by different routes e.g. oral, vaginal, subdermal, and many others. She can use the contraceptives in different forms that suit her. They block ovulation by preventing the secretion of two other hormones, the follicular stimulating hormone, and the luteinizing hormone. The pituitary gland secretes the two later natural hormones that are located at the base of the brain
Hypertension in Women
Hypertension (high arterial blood pressure) is a major health problem worldwide with prevalence in women of more than 25% of adult females all over the world. The attack of hypertension is associated with the increase in the rate of deaths among women. The cause of hypertension is considered to be the presence of an interrelationship between the genetic factors and the environmental factors. Oral contraceptives are the most important environment factors that exert a major impact on women blood pressure.
The recommendation adopted by the WHO for women suffering from hypertension is the use of the hormone-free pills. Pills that contain progesterone alone are also safe for women with hypertension. Although studies on 35 women showed that the combined hormonal contraception is safe, the WHO criteria do not recommend the use of combined contraceptives due to the lack of backing scientific proof.
Hormone contraceptives and hypertension
The studies showed a lack of association between the use of progestogen alone for contraception and the elevation of blood pressure in healthy women i.e. with no hypertension. Recent epidemiological research has reported that administration of hormone contraceptives affects the blood pressure negatively. The elevation of blood pressure either systolic or diastolic and the elevation of the prevalence of hypertension depends on the duration of oral contraceptives administration. The conducted research handled the first and second generations of hormone contraceptives with relatively high estrogen contents. Monitoring with caracal will help better manage hypertension.
The third-generation oral contraceptives
The promising new oral contraceptives that contain a low level of estradiol is supposed to minimize the risk of untoward health effects. However, the risk of hypertension is still a threat to the womans health. The controversy exists that concern the contribution of the new drugs to the development of cardiovascular disease in women mediated by elevation of blood pressure
Most studies reported a sustained increase in both systolic and diastolic blood pressure in women using the third-generation oral contraceptives that are a combination of estrogen and progestin. The level of such elevation varies according to many factors including duration of drug use
A promising drug
Drospirenone is a newly emerging medication that possesses anti-mineralocorticoid properties (steroid hormones acting on salt and water regulation in the body). Although it is related to aldactone, it has no effect on potassium blood level. A Recent study showed that 20 mcg of ethinyl estradiol (30 in the market) and 3 mg of drospirenone have no relevant effect on hypertensive women either clinically, neurologically, or metabolically. So, it is suggested that hypertensive women in the reproductive age can have such combination for contraception.
- Tough, K., & Thacker, H. (2012). Update on contraceptive options: A case-based discussion. Cleveland Clinic Journal of Medicine, 79(3), 207-212. http://dx.doi.org/10.3949/ccjm.79a.11088.
- Farley, T., Collins, J., & Schlesselman, J. (1998). Hormonal Contraception and Risk of Cardiovascular Disease. Contraception, 57(3), 211-230. http://dx.doi.org/10.1016/s0010-7824(98)00019-5.
- Elliott, W. (2006). Global Burden of Hypertension: Analysis of Worldwide Data. Yearbook of Cardiology, 2006, 4-5. http://dx.doi.org/10.1016/s0145-4145(07)70005-9.
- Wei W, Li Y, Chen F, Chen C, Sun T, Sun Z, Wu Y, Zhou J, Ba L. (2011). Dyslipidaemia, combined oral contraceptives use and their interaction on the risk of hypertension in Chinese women. J Hum Hypertens, 25:364–371. doi: 10.1038/jhh.2010.67.
- Hussain, S. (2004). Progestogen-only pills and high blood pressure: is there an association?. Contraception, 69(2), 89-97. http://dx.doi.org/10.1016/j.contraception.2003.09.002.
- Shufelt, C., & Bairey Merz, C. (2009). Contraceptive Hormone Use and Cardiovascular Disease. Journal of The American College of Cardiology, 53(3), 221-231. http://dx.doi.org/10.1016/j.jacc.2008.09.042.
- World Health Organization. Medical eligibility criteria for contraceptive use. 4rd ed. Geneva; 2009.
- Lubianca JN, Faccin CS, Fuchs FD. (2003). Oral contraceptives: a risk factor for uncontrolled blood pressure among hypertensive women. Contraception, 67:19–24. doi: 10.1016/S0010-7824(02)00429-8.
- Grossman D, White K, Hopkins K, Amastae J, Shedlin M, Potter JE. (2011). Contraindications to combined oral contraceptives among over-the-counter compared with prescription users. Obstet Gynecol, 117:558–565. doi: 10.1097/AOG.0b013e31820b0244.
- Giribela CR, Melo NR, Silva RC, Hong VM, Guerra GM, Baracat EC, Consolim-Colombo FM. (2012). A combined oral contraceptive containing drospirenone changes neither endothelial function nor hemodynamic parameters in healthy young women: a prospective clinical trial. Contraception, 86:35–41. doi: 10.1016/j.contraception.2011.08.017.
- Park, H., & Kim, K. (2013). Associations between oral contraceptive use and risks of hypertension and prehypertension in a cross-sectional study of Korean women. BMC Women’s Health, 13(1). http://dx.doi.org/10.1186/1472-6874-13-39.
- Morais, T., Giribela, C., Nisenbaum, M., Guerra, G., Mello, N., Baracat, E., & Consolim-Colombo, F. (2014). Effects of a contraceptive containing drospirenone and ethinylestradiol on blood pressure, metabolic profile and neurohumoral axis in hypertensive women at reproductive age. European Journal of Obstetrics & Gynecology and Reproductive Biology, 182, 113-117. http://dx.doi.org/10.1016/j.ejogrb.2014.09.006