Contraceptive Strategies in Women With Heart Failure or With Cardiac Transplantation

Abstract

Purpose of review: We describe contraception for two groups of women: (1) women with heart failure and (2) women with cardiac transplantation.

Recent findings: Medical Eligibility Criteria for contraceptive agents address women with peripartum cardiomyopathy and women with valvular heart disease (Curtis et al. MMWR Recomm Rep 65:1-103, 2016). Recommendations for women with other forms of heart failure are extrapolated from these populations. Recommendations for women with cardiac transplantation have shifted since the 1980s: use of long-acting reversible contraception has increased, and there is a better understanding of the interactions between contraceptive and immunosuppressive regimens. Women with heart failure may utilize long-acting reversible contraception and permanent sterilization. Modifications should be made according to the specific etiology of the heart failure. In women with cardiac transplantation, pregnancy is high risk and should be avoided altogether for 1-2 years after transplantation. In uncomplicated transplantation, almost all forms of contraception are allowable. In complicated transplantation, combined hormonal contraceptives are contraindicated, and de novo IUD insertion is not recommended.

Keywords: Cardiac transplantation; Cardiomyopathy; Contraception; Estrogen and progesterone; Heart failure; Intrauterine device.