According to the WHO, as of 2018, there are at least 20 family planning methods available to the public. Each couple can choose the best method of pregnancy control for themselves.
For each of the contraceptive methods there are clear indications and contraindications that must be taken into account.
The presence of somatic diseases in a woman requires a thorough examination, the establishment of an accurate diagnosis and a differentiated choice of contraceptive, taking into account modern recommendations based on evidence-based medicine (Evidence-Based Medicine Guidelines).
On the correct choice of the family planning method for somatic pathology read on estet-portal.com in this article.
Recommended methods of contraception in the presence of cardiovascular disease
• Pathology of the valvular apparatus (including overt mitral valve prolapse), myocardial infarction, stroke.
Subcutaneous progestogen implants and progestogen tablets (mini-pills) are the drugs of choice. It is also acceptable to use hormonal preparations containing progestin and a copper intrauterine device (IUD) in a stable sexual partnership.
Combined oral contraceptives (COCs) are not recommended due to an increased risk of thromboembolism!
214 million women would like to delay or exclude the possibility of pregnancy, but do not use modern methods of family planning.
• Hypertension
Possible methods of contraception are copper or progestogen IUDs, as well as progestogen tablets, implants or injections.
COCs with low estrogen content are absolutely contraindicated if the disease is in a decompensated state.
The appointment of drugs containing drospirenone is promising. At the moment, there are not enough studies conducted in patients with hypertension.
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Recommended methods of contraception in the presence of metabolic diseases
• Diabetes mellitus
COCs may interfere with insulin response. Low-dose COCs are safe in young, nulliparous women; hormone-releasing IUDs are also possible.
The hormone-releasing and copper IUD and sterilization are recommended for older women.
You may also be interested in our article: What changes in the skin occur with diabetes.
• Dyslipidemia
Suitable COCs are those containing desogestrel, gestodene or drospirenone, as well as hormone-releasing IUDs, copper IUDs, and progestogen-containing subcutaneous implants. If dyslipidemia is associated with coronary artery disease, COCs are contraindicated.
• Polycystic ovary syndrome (PCOS)
COCs with desogestrel, drospirenone, gestodene or cyproterone acetate are suitable as a progestogenic derivative.
For acne, COCs containing cyproterone acetate, drospirenone, or desogestrel as progestin are the drugs of choice.
• Liver diseases in the stage of decompensation
Only copper IUDs and barrier methods are allowed due to impaired drug metabolism in the compromised liver.
• Thyroid disorders
No special recommendation. However, obesity in myxedema with a body mass index of 30 kg/m2 and above reduces the effectiveness of COCs. The use of COCs in the case of obesity increases the risk of thromboembolism. Therefore, the method of choice for such patients are mini-pills (gestagen-containing tablet contraceptives) and intrauterine contraceptives (levonorgesterel-releasing system).
Recommended methods of contraception in the presence of neurological diseases
• Migraine
COCs worsen migraine symptoms in one in three patients. IUDs or progestin-containing drugs are acceptable in such cases.
Due to an increased risk of thrombosis, COCs are contraindicated in women who have migraine with aura and women over 35 who have migraine without aura.
• Epilepsy
The hormone-releasing IUD is the main option.
Phenobarbital, phenytoin, carbamazepine, and paramethadione induce enzymes that metabolize contraceptive steroids, so the risk of pregnancy increases due to drug failure.
Patients taking benzodiazepines or valproates can take COCs without an increased risk of unwanted pregnancy.
• Psychoses, Addictions
COCs may increase the tendency to depression in some patients. However, they are not contraindicated.
Recommended methods of contraception in the presence of other somatic diseases
• Rheumatic diseasesCOCs can relieve the symptoms of rheumatoid arthritis, as well as pregnancy itself.Combined oral contraceptives containing second-generation progestins are recommended for SLE. COCs containing progestins may also be used.
COCs may increase the risk of recurrence of hormone-dependent breast cancer or promote metastasis of the disease. COCs are not contraindicated in patients with cervical carcinoma.
Hypertension associated with kidney failure may affect the choice of contraceptive method (See Hypertension).
Thus, when choosing a method of contraception, it is necessary to take into account the pathology of the patient from all organs and systems. The functional state of the body and taking medications for the underlying disease can affect the bioavailability and biotransformation of contraceptives, slow down the excretion of their metabolites and reduce effectiveness.
Thank you for staying with estet-portal.com. Read more in the section "Gynecology" in our article:
How to choose the right oral contraceptives: indications and contraindications
Adapted from the Evidence-Based Medicine Guidelines.
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