Hormonal contraceptives’ effect on blood pressure depends on the type of synthetic estrogen/progestin and hormone dosage.
The hormones in oral contraceptives differ from naturally occurring hormones. Natural estrogen has a blood pressure lowering effect. Synthetic estrogens (including those used in contraceptive pills, patch and ring) have a neutral or blood pressure elevating effect. Contraceptive progestins have varying degrees of androgenic activity, whereas natural progesterone is non-androgenic. This difference may account for the blood pressure elevating effects of synthetic progestins. Increased blood pressure is associated with higer progestin potency. Because progestin injection contains a higher dosage than progestin pills, implants, or IUDs, the injection is more likely to raise blood pressure.
Which contraceptives can hypertensive women safely use? According to the U.S. Medical Eligibility Criteria for Contraceptive Use:
- Women who had hypertension during a prior pregnancy (now resolved) may use estrogen-containing contraceptives with a mild caution (“2”); we should check their blood pressure after they start taking the new method. These women can use all other hormonal methods without restrictions(“1”).
- For women with ongoing, but relatively well-controlled hypertension (systolic blood pressure < 159 and diastolic blood pressure < 99), estrogen-containing contraceptives get a “3,” meaning that they are relatively contraindicated. Progestin injection gets a “2” because of its relatively high dose. All other hormonal methods can be used without restrictions (“1”).
- For women with poorly controlled hypertention, estrogen-containing methods get a “4,” progestin injection gets a “3,” and all other hormonal methods get a “2.” Only the copper IUD can be used without restrictions (“1”).
Many women with hypertension have other medical problems as well. To choose the best birth control method for these women, consult an easy-to-use guide on Medical Eligibility for Initiating Contraception.
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The Reproductive Health Access Project does not accept funding from pharmaceutical companies. We do not promote specific brands of medication or contraception. The information in the Contraceptive Pearls is unbiased, based on science alone.