Contraception in women with special medical needs

Abstract

Over 10% of women of reproductive age have experienced a serious chronic physical disorder. Reproductive health issues including contraception are frequently ignored in these individuals. Clinicians should have available current knowledge regarding interactions between contraception and these conditions.

PIP: Over 10% of US women have experienced a serious chronic physical disorder or disease by the age of 18 years. Nonetheless, health professionals frequently are unprepared to counsel women with special medical problems about sexuality issues, including the potential adverse effects of pregnancy and contraception on underlying disease. This article, based on a comprehensive review of the clinical literature, summarizes significant contraception-related considerations in women with specific medical conditions. Special emphasis is awarded to cardiovascular and neurologic diseases. In women with cardiac disease, both the cardiovascular sequelae of pregnancy should the contraceptive fail and the potential adverse circulatory effects of various contraceptive methods must be considered. In women with neurologic disease, a method must be selected that will not interact with anticonvulsants or immunosuppressive medications. Also reviewed are indicated and contraindicated contraceptive methods for women with pulmonary, gastrointestinal, endocrine, hematologic, renal, and rheumatologic disease; HIV/AIDS; cancer; and psychiatric morbidity. Tables review World Health Organization medical eligibility criteria for use of the major contraceptive methods, medications that potentially reduce or enhance the efficacy of oral contraceptives (OCs), and drugs whose efficacy may be affected by concomitant OC use.