The risk of pregnancy for women with congenital heart disease ranges widely depending upon the kind of heart lesion and associated systemic complications.. For some women, their risk is no different from that of the general population. For others it carries a prohibitive risk of death for the woman and/or the baby. For these women, birth control is more than just a method to conveniently space babies. It may prevent a life-threatening pregnancy.
Options available to patients with congenital heart lesions:
-Barrier methods (i.e., condom, diaphragm)-These are safe for all users. Condoms have the added advantage of preventing STDs (sexually transmitted diseases). However, they are “operator-dependent.” Hence not a good choice if you are at high cardiac risk from an unplanned pregnancy
-Combined oral contraceptive pill (estrogen and progestin) For women with heart disease who are anticoagulated, increases in menstrual bleeding may not be insignificant. Estrogen and progestin can interfere with the action of anticoagulant drugs. Also,estrogen should not be used in patients with History of blood clots (thrombosis) or a known blood clot disorder and Certain kinds of heart rhythm problems
-Progestin-onlyoptions: safe, but not very effective due to the need for exact dosing every 24 hours. Unplanned pregnancies can occur when dosing is delayed by only a few hours.
-Emergency contraception: Emergency contraception is safe. It only contains progestin (levonorgestrel), so there is no added blood clot risk associated with pills with estrogen. The single tablet should be taken within 72 hours of unprotected sexual intercourse..An interaction between warfarin and high-dose Levonogestrel may exist; therefore, monitoring of international normalized ratio (INR) is recommended.
-Injection: Depo-Provera is a highly effective injectable method of contraception. It must be given consistently every three months. It is safe for all women with congenital heart disease. The main side effect is menstrual irregularities and spotting, as well as weight gain. Menstrual bleeding may stop altogether after the first few months of use. It is important to know that fertility returns to normal rapidly if you stop taking it. You can get pregnant even before your period returns.
-Intrauterine devices:A copper intrauterine device, or IUD and a progestin-releasing IUD (Mirena) are very effective and safe forms of birth control. The copper IUD carries a higher risk of increased uterine bleeding and infection. If you have an active STD, abnormal Pap smear, or pelvic infection, you should not use either of these. There is also pain when the IUD is put in, particularly in women who have not previously given birth. Some women feel faint during this procedure.Mirena thins out the uterine lining over time leading to scant or absent menses. Before having the IUD put in, if you have complex cardiac problem (i.e. Fontan, pulmonary hypertension) you should ask your gynecologist to talk to your cardiologist. This is to see if there are precautions that should be taken to make the insertion free of complications.
-Sterilization (surgical and non-surgical)/Sterilisation of partner-This is 100% safe for you, but only if you have no other sexual partners. Like all sterilization, it is not 100% effective. You and your partner also need to consider the difficult issue of how he might feel in the future if something happened to you.
Consideration of what heart medications are used as well as the type and severity of the heart problem should be considered as well. Input from the patient, obstetrician, and cardiovascular specialist are recommended.