Birth control and high blood pressure: Which methods are safe for you? – Harvard Health Blog

Three effective forms of birth control contain the hormone estrogen: the birth control patch, combined hormonal birth control pills, and a vaginal ring. Doctors have typically recommended that women avoid birth control with estrogen if they have high blood pressure, which current US guidelines define as 130 mm Hg systolic pressure and 80 mm Hg diastolic pressure, or higher. A recent clinical update in JAMA clarifies whether it’s safe for some women with high blood pressure to use these forms of birth control.

Why does blood pressure matter when choosing birth control?

Birth control containing estrogen can increase blood pressure. When women who have high blood pressure use these birth control methods, they have an increased risk of stroke and heart attack compared with women who do not have high blood pressure. However, their actual chances of having a stroke or a heart attack are still quite low.

When considering birth control options, it’s important to also weigh the possible risks of an unintended pregnancy. A woman who has a history of high blood pressure before she becomes pregnant is more likely to experience

  • preeclampsia, a pregnancy complication that can affect liver and kidney function and can even lead to eclampsia, or seizures
  • diabetes during pregnancy
  • blood clots
  • heart attack

She’s also at higher risk for problems with fetal growth and preterm birth.

Why are recommendations around blood pressure and birth control being updated?

When US blood pressure guidelines changed in 2017, many more people were diagnosed with high blood pressure. That happened because the new guidelines tightened standards, as follows:

  • normal blood pressure is less than 120 (systolic)/80 (diastolic) mm Hg
  • elevated blood pressure is between 120 and 129 mm Hg (systolic) and less than 80 mm Hg (diastolic)
  • high blood pressure is 130 mm Hg (systolic)
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