Contraception advice for women and birthing people with heart disease

Planning Ahead

After the birth of your baby, you can be fertile very soon afterwards, before resuming your menstrual periods, even if you are exclusively breastfeeding or chestfeeding. If you have heart disease, a further pregnancy after a short interval may be inadvisable, as it may place you at higher risk, or you may need additional treatment for your heart before considering another pregnancy. In many cases, it is recommended that we discuss a future pregnancy with you before you start trying to conceive, so that we can make sure pregnancy is as safe for you and your baby as possible.

For these reasons, it is important to consider contraception that may be suitable for you after birth, taking into account your medical conditions. Advice will be tailored to your individual circumstances, but we usually recommend at least 12 months before getting pregnant after a vaginal birth and at least 18 months after a caesarean birth, however these timings may be different for you and your family.

Below is some general advice about contraception options that may be suitable if you have heart disease. All contraception is free in the UK. Please read the information, consider your preferences, and discuss your specific needs further with the team during your clinic appointments.

Long Acting Reversible Contraceptives (LARCs)

These methods are reliable and can be stopped if you wish to become pregnant again. They are all safe to use if breastfeeding or chestfeeding.

• Intrauterine contraceptives/coils: these can be inserted at the time of caesarean birth, immediately after vaginal birth (<4hrs), or 6 weeks after birth. They are 99% effective at preventing pregnancy, and can be removed at any time.
  • Mirena (progesterone) coil: may improve period pain, lighten periods and you may experience no periods, so this can be beneficial if you have heavy and/or painful periods. It lasts for 3-8 years.
  • Copper (non-hormonal) coil: is suitable for those who want non-hormonal contraception and who do not have heavy periods, as this can be a side effect. It lasts for up to 5 years.

Inserting a coil does not significantly increase the amount of time taken to perform a caesarean birth or the risks associated with having a caesarean birth.

The risk of a coil coming out of the uterus is higher when placed after birth than at other times. It is therefore important to check your sanitary pads to make sure the coil has not come out, and to attend for a coil check at your GP surgery or at a sexual health clinic 4-6 weeks after the coil is placed. If you are unable to be seen as above, then please contact us and we will arrange to see you in the Rosie. There are threads attached to contraceptive coils which hang through the cervix (opening of the uterus). If placed at the time of birth, these threads are left long, and as your uterus returns to its pre-pregnancy size after having your baby (this takes about six weeks), you may need to have the threads trimmed. This can be done at your coil check.

• Implant: can be inserted in the hospital after birth, before you are discharged home, or later by your GP or at a sexual health clinic. The implant is a small, flexible rod placed under the skin in the upper arm, and releases progesterone hormone. It is 99% effective at preventing pregnancy for up to 3 years, and can be removed any time.
• Depot injection: can be started in the hospital after birth, before you are discharged home. The depot is an injection of progesterone hormone, which is repeated every 3 months by your GP or at a sexual health clinic. Depending on your heart condition, this may not be suitable if you have ischaemic or coronary artery disease.

The Pill

There are two main types of contraceptive pill: the combined pill, which contains the hormone oestrogen and is often not suitable for people with heart disease, and the progesterone-only pill (mini-pill). Our pregnancy heart team can provide additional advice on the type of contraceptive pill that would be suitable for you, depending on your heart condition.

• Progesterone-only pill: can be started in hospital after birth (any time within 3 weeks), and is safe to use if breastfeeding or chestfeeding. Some people opt for the progesterone-only pill while deciding on a longer-term contraception (i.e. prior to getting a contraceptive coil). It is 91% effective at preventing pregnancy. It needs to be taken daily and at the same time every day, which can be difficult to do with a new baby. Your GP can issue repeat prescriptions as necessary.

Permanent Contraception

These methods are suitable for people who have decided their family is complete.

• Sterilisation/tubal ligation: for people planning caesarean birth, this can be done during the surgery. It involves cutting and tying, or completely removing, the fallopian tubes so eggs can no longer be fertilised by sperm. Your periods still occur as usual. The procedure is more than 99% effective at preventing pregnancy, and is a permanent form of contraception. Sterilisation can be performed under anaesthetic on a separate occasion.
• Vasectomy: male partners can be sterilised by having a procedure known as vasectomy. It is a short procedure done under local anaesthetic, and is a permanent form of contraception. It is more than 99% effective at preventing pregnancy. Men considering vasectomy should discuss this with their GP.

Please note, although the above contraception options are effective at preventing pregnancy, they do not offer protection from sexually transmitted infections. If you are having sex with a new partner, you should always use condoms as well.

Resources

NHS Inform - general information about different types of contraception (opens in a new tab)

NHS contraception guide - choosing a method of contraception (opens in a new tab)

British Heart Foundation - contraception and pregnancy with heart disease (opens in a new tab)

Faculty of Sexual and Reproductive Healthcare - Clinical guideline contraceptive choices for women with disease (opens in a new tab)