While using birth control has many advantages, there are some pre-existing risks or conditions that must be considered when choosing a birth control method. For example, conditions like diabetes, migraines with aura, liver or gall bladder disease, blood clots, stroke or heart disease, cancer, and high blood pressure. In this article, we will look at why high blood pressure matters when choosing a birth control, and which birth control methods to use when one is at risk of or suffering from high blood pressure. What is blood pressure and high blood pressure?
Blood pressure is the pressure exerted by the circulating blood in the body against the blood vessel walls.
The normal blood pressure in humans is considered to be 120 mmHg systolic (when the heart is contracting) and 80 mmHg diastolic (when the heart is relaxing). Any increase above this 120/80 mmHg level is considered to be some form of high blood pressure or hypertension. According to the latest guidelines, there are 4 stages of hypertension:
Stage | Systolic blood pressure(SBP) | Diastolic blood pressure (DBP) |
Pre-hypertension | 120-129 mmHg | <80 mmHg |
Hypertension stage 1 | 130-139 mmHg | 80-89 mmHg |
Hypertension stage 2 | > 140 mmHg | > 90 mmHg |
Hypertensive crisis | > 180 mmHg | > 120 mmHg |
What’s the relationship between birth control and blood pressure?
Birth control methods like the birth control patch and combined hormonal birth control pills contain the hormone estrogen. The mechanism of these methods uses the naturally produced female hormones, estrogen and progesterone, in a modified way to regulate the menstrual cycle and in turn prevent ovulation and pregnancy.
Birth control methods containing estrogen can increase blood pressure. The mechanisms responsible for this effect are poorly understood. It is believed that the renin-angiotensinogen system, which is a feedback loop that maintains blood pressure, is involved. Estrogen is believed to be responsible for increasing the levels of angiotensinogen, and ultimately blood pressure.
Therefore, women who have high blood pressure are discouraged from using estrogen-containing birth control methods due to an increased risk of stroke and heart attack, compared with women who do not have high blood pressure. It's important to note though that although there’s an increased risk, their actual chances of having a stroke or a heart attack are still quite low. However, the risk is much higher for women who smoke regularly and are older than 35. So while studies have shown that estrogen-containing birth control methods like the birth control patch and combined birth control pill are largely safe, and most women who use these methods experience either no side effects or minor side effects which usually disappear after 1 to 3 months, it is typically recommended that women with high blood pressure avoid using any birth control with estrogen. If you have high blood pressure, talk to your doctor to choose a birth control method that is suitable for you. What should I do to reduce the risk of high blood pressure?
If you use an estrogen-containing birth control method like birth control patch or combined birth control pills, get your blood pressure checked every 6 months to make sure it stays within a healthy range.
At the same time, it is recommended that you maintain a healthy body weight, consume a well-balanced diet low in saturated fats, exercise 150 minutes a week, avoid smoking, and reduce your stress levels so that you can minimize the risk of hypertension and any related problems.
If you already have high blood pressure or any of the previously mentioned conditions or risk factors, talk to your doctor who will weigh the pros and cons, and choose an alternative birth control method that is most suitable for you. Which birth control method can I use if I have high blood pressure?
There are a variety of other birth control methods available, both hormonal and non-hormonal. These include:
Progestogen-only pills - The synthetic version of progesterone is called progestogen or progestin. Progestogen- or progestin-only pill, more commonly known as minipill, are birth control pills with no estrogen, and can therefore be taken safely by those with high blood pressure or hypertension.
Intrauterine Devices (IUDs) - Copper IUD and levonorgestrel-containing IUD do not contain any estrogen and have a high efficacy as a contraceptive.
Non-hormonal methods - Male/female condom, diaphragm, and cervical cap are all viable options for those who are at risk of or suffer from hypertension. However, these are not as effective as other methods mentioned above.
It is advisable that you consult a doctor before starting on any birth control method so that the doctor can assess any existing risks before recommending the right birth control for you.
We hope that you found this article helpful. If you have any questions or would like to book an appointment with one of our doctors, feel free to reach out to us!
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References
Kasper, D. L., et al. Harrison's principles of internal medicine (20th edition.). New York: McGraw Hill Education., 2018. (pg. 3440-3446)
https://www.uptodate.com/contents/contraception-hormonal-contraception-and-blood-pressure
https://pubmed.ncbi.nlm.nih.gov/12263383/
https://journals.lww.com/jhypertension/Abstract/2017/06000/Angiotensin_II_Angiotensin__1_7__ratio_and_24_h.9.aspx
https://www.health.harvard.edu/blog/birth-control-and-high-blood-pressure-which-methods-are-safe-for-you-2020111321327