Contraceptive methods for women with pulmonary arterial hypertension (PAH)
| Type of contraceptive (trade name) | Comments |
| Hormone-based methods | |
| Progestogen-only | |
| Progesterone-only pill | May have reduced efficacy in women taking bosentan and should not be used as the sole method of contraception in these patients [1, 2, 10, 13] |
| Injectable progestin (Depo-provera®) | One meta-analysis has shown an increased risk of VTE when injectable progestin is administered [14] |
| Progestogen implant (Implanon®) | May have reduced efficacy in women taking bosentan and should not be used as the sole method of contraception in these patients [1, 2, 10, 13] |
| Hormone-releasing IUS (Mirena) | Risk of infection at time of insertion [13] |
| Occasional vasovagal reaction when inserted, which is poorly tolerated in severe PAH [10, 13] | |
| Emergency hormonal contraception | Emergency contraception is not recommended as a regular long-term contraceptive technique due to its high annual failure rate, plus its lack of protection against sexually-transmitted infections [13] |
| May have reduced efficacy in women taking bosentan [13] | |
| Oestrogen and progestin combination | |
| Combined oral contraceptive pill | The oestrogen component is associated with increased risk of arterial thromboembolism and VTE [3, 10, 13]; anticoagulation does not protect entirely against the thrombotic risk [13] |
| Transvagal ring (NuvaRing#) | |
| Contraceptive patch (EVRA#) | |
| Non-hormonal methods | |
| Copper-T IUD | Less frequent replacement required than the Mirena IUS [13] |
| Risk of endocarditis likely to be greater than the Mirena IUS [13] | |
| Barrier methods | Barrier contraceptive methods are safe for the patient, but with an unpredictable effect [1, 2] |
| Permanent methods | |
| Female sterilisation | Sterilisation can be performed electively, post-abortum, post-partum or at the time of caesarean section, avoiding the risks of a separate procedure; however, the failure rate is reportedly higher in this setting [10] |
| Hysteroscopic methods are associated with the potential for lower procedural risks than other permanent contraception methods [3] | |
| If tubal ligation is planned, a mini-laparotomy may be a safer method than a laparoscopic approach due to procedural risks [3] | |
| Male sterilisation | Male sterilisation can be performed under local anaesthesia. It is also cheaper and associated with a lower failure rate and fewer complications compared with female sterilisation [10] |
VTE: venous thromboembolism; IUS: intrauterine system; IUD: intrauterine device. #: not available in the UK.