Pregnancy and contraception
Pregnancy
Pregnancy places a significant strain on the heart and lungs. This can result in life threatening problems for patients with pulmonary hypertension. In addition some of the drugs which are used to treat pulmonary hypertension can harm the development of the baby.
Our advice is to avoid becoming pregnant. If, in the knowledge of the risks, you still wish to become pregnant, please discuss this with a member of the SPVU team.
Contraception
The combined oral contraceptive pill is not recommended because of the risk of developing clots in the legs or lungs. Many of the agents that are used to treat pulmonary hypertension interfere with contraceptive pills and implants and result in contraceptive failure.
It is therefore recommended that 2 forms of contraception should be used to ensure full protection. This would usually be in the form of a hormonal tablet, such as the progestogen only pill, and a barrier method, such as the male condom.
Progestogen only oral contraceptive pill
We would currently recommend Cerazette. It inhibits ovulation directly and should be taken at the same time each day. The active ingredient is a hormone called desogestrel. It can cause some irregular bleeding. There is a specific interaction which has been identified for bosentan and the progestogen only pill. This drug can reduce the levels of the hormone in the bloodstream and therefore reduce effectiveness. Our advice remains that you should use two forms of contraception when on bosentan. This should be one hormonal and one barrier method.
Implantable long term contraception
Implanon is a small rod which is inserted under the skin, usually in the upper arm. This contains a progestogen called etonogestrel which is released continuously and provides adequate contraception for up to 3 years. It can be used even if you are on warfarin. Insertion and removal may cause mild discomfort.
Intrauterine system (Mirena)
This is a small coil inserted into the womb. In addition to being a physical barrier it releases a progestogen called levonorgestrel which makes fertilised eggs less likely to implant in the womb. Insertion occasionally causes fainting so it should be inserted by an experienced doctor or nurse. It can last for up to 5 years. One additional advantage is that it can help women with heavy or painful periods. There is a slight risk that it can become displaced and pass out from the womb unnoticed which would lead to contraceptive failure but this is very uncommon.
Depot contraception injection
This involves a deep intramuscular injection of a progestogen called medroxyprogesterone acetate and lasts up to 12 weeks. This prevents the release of the egg from the ovary. This is effective and convenient but it can result in significant bruising in patients taking warfarin. The warfarin level (INR) should be below 3.
Intrauterine Devices (Coil)
The most well known is the copper containing coil (Copper T380) which is inserted into the womb. This blocks the passage of sperm into the womb. It is free from drugs and is safe. It can last 5-10 years. Insertion occasionally causes fainting so it should be carried out by a trained professional.
Other contraceptive methods
We do not recommend the female condoms, the cap plus spermicide or natural planning methods but would encourage the use of the male condom in conjunction with one of the contraceptives listed above.
Emergency Contraception
Emergency contraception is available but should not be viewed as a form of regular contraception. The two main methods are insertion of an intrauterine device which can be inserted up to 5 days after sexual intercourse or the progestagen-only emergency contraception. This must be taken within 72 hours of sexual intercourse (2 progestagen containing tablets 12 hours apart).