If you have hypertension or prehypertension, it’s important to stay aware of the effects that birth control could have on your health.
Every year, tens of millions of women in the United States and hundreds of millions of women worldwide use hormonal birth control to protect themselves from becoming pregnant. Overall, birth control is very safe, with few serious side effects or major health risks.
However, some forms of birth control have the potential to affect your blood pressure, leading to health risks if you have hypertension or prehypertension.
Below, we’ve covered how some types of hormonal birth control can affect your blood pressure and cardiovascular health. We’ve also listed safe forms of birth control for you to consider if you have hypertension, prehypertension or other health issues related to blood pressure.
For the most part, birth control pills (as well as other forms of hormonal contraception, such as the patch, ring and injection) are safe.
Most women who use birth control experience either no side effects, or minor side effects — like nausea, breast tenderness, headaches and dizziness — that usually disappear after two to three months.
However, some forms of birth control can cause an increase in blood pressure. These include most birth control pills, patches, rings and other forms of birth control that use hormones such as estrogen.
According to a 2012 study, about eight percent of all women of reproductive age and more than 18 percent of women specifically aged 40 to 44 have hypertension, making this a fairly common problem.
Birth control pills come in three different types. The first, and most common, is the combined birth control pill (also known as a combined oral contraceptive pill, or “COCP”).
Combined birth control pills use a combination of estrogen and progestin hormones to prevent your ovaries from releasing eggs. These hormones also affect your cervical mucus, helping to block sperm from coming into contact with an egg.
From a birth control standpoint, these hormones are highly effective. Modern birth control pills are 99 percent effective at preventing pregnancy when used perfectly and about 91 percent effective under “real life” conditions, with the occasional missed or late pill.
The hormones in combined birth control can affect your blood pressure. Studies show that estrogen is closely linked to an increase in your systolic and diastolic blood pressure levels, although this increase is often fairly mild.
In a 1981 study, researchers found that some women developed hypertension after they started to use oral contraceptives that contained estrogen. Another study from 2006 also found that use of endogenous estradiol (an estrogen hormone) is linked to a small increase in blood pressure in postmenopausal women.
A 1996 study involving over 68,000 women ages 25 to 42 found that current users of oral contraceptives had a “significant, moderately increased risk” of being diagnosed with hypertension.
It also found that risk of hypertension decreased after cessation of use, that women who previously used oral contraceptives but stopped had a slightly increased risk of being diagnosed with hypertension down the road and, importantly, that overall risk, despite being significant over non-oral contraceptive users, was still low — only 41.5 cases occurred in ten thousand people-years of study.
Overall, the average increase in blood pressure levels from combined birth control pills is fairly small. However, if you already have hypertension or prehypertension, the small increase in your blood pressure that you might experience from birth control could be bad for your health.
The second form of birth control pill is the progestin-only pill, or “mini-pill.” Unlike the combined birth control pill, the progestin-only pill doesn’t contain any estrogen. Instead, it uses a smaller dose of a progestin hormone to stop you from becoming pregnant.
Progestin-only pills don’t always stop you from ovulating. Instead, they mainly stop pregnancy by thickening your cervical mucus. Like combined birth control pills, they’re very effective, with an effectiveness rate of 99 percent if used according to the instructions.
Because progestin-only birth control pills don’t contain estrogen, they tend to have a smaller effect on blood pressure than combined birth control pills.
For instance, a meta-analysis of 19 studies on progestin-only contraceptives found no influence on blood pressure through the use of these types of birth control.
If you have high blood pressure, your healthcare provider may recommend against using the combined birth control pill until it is managed and under control.
While this can seem inconvenient, it’s an important health precaution. if your blood pressure is already above the optimal or normal range, the increase you might experience from combined birth control may put you at risk for significant health problems.
Your risk of developing high blood pressure is also higher if you’re a smoker, if you’re overweight or obese, or if you have conditions such as sleep apnea or diabetes.
Other risk factors for high blood pressure include:
If you have any health conditions or habits that could affect your blood pressure, it’s important to mention them to your healthcare provider when you’re discussing birth control options.
While high blood pressure could prevent you from using the combined birth control pill, it doesn’t mean you can’t use birth control at all. A wide range of safe, blood pressure-friendly birth control options are available to help you stay protected from pregnancy without affecting your health.
Because condoms don’t contain any hormones, they’re completely safe to use if you have high blood pressure or prehypertension. Unlike hormonal birth control, condoms can also keep you safe from sexually transmitted diseases.
Since the progestin-only pill doesn’t contain estrogen, it may not cause such a significant increase in blood pressure.
Studies show that the progestin-only does not have any significant association with high blood pressure. Because of this, the progestin-only pill is usually considered a safe alternative to the combined pill for women with hypertension or high blood pressure risk factors.
However, it’s still important to talk to your healthcare provider about this option, as research is still somewhat thin — make sure to tell them about your health history, other medications you’re on, etc.
The progestin-only pill is equally as effective as the combined birth control pill. However, since it only contains a small amount of hormones, it’s particularly important that you take it at the same time every day.
Since the progestin-only pill doesn’t contain any estrogen, it doesn’t have the same benefits for your skin as combined birth control. Like combined birth control, you’ll still need to talk to your healthcare provider before you can safely use it to prevent pregnancy.
Our guide to the differences between the combined birth control pill and the progestin-only pill covers this topic in more detail, with specific data on the effects each type of birth control pill can have on your health and wellbeing.
The birth control implant, sold in the US as Nexplanon®, is a small rod that’s implanted into your arm as a form of contraception. It’s about the same size as a matchstick and offers up to three years of protection from pregnancy.
Like the progestin-only birth control pill, the implant doesn’t use estrogen. Instead, it releases a small amount of etonogestrel, a synthetic progestin hormone, to prevent you from ovulating and reduce your risk of becoming pregnant.
Similar to other progestin-only forms of contraception, the birth control implant also affects your cervical mucus, making it more difficult for sperm to come into contact with an egg.
Because the implant is inserted into your body, there’s no need to worry about taking a pill every morning. This gives the implant one of the highest success rates of any form of birth control, with a more than 99 percent effectiveness rate at preventing pregnancy.
The implant lasts for three years at a time and needs to be replaced in order to offer continual protection. While it sounds scary, the process of inserting and removing the implant is simple, with a small incision made into your arm under local anaesthesia in your healthcare provider’s office.
In short, it’s a quick, easy and pain-free process, with your arm numbed to make sure you don’t feel anything. In exchange, you’ll be protected against pregnancy for three years, all with little to no effects on your blood pressure.
Both copper and hormonal IUDs have little to no impact on your blood pressure, making them a worthwhile alternative to the pill if you have hypertension or prehypertension.
IUDs work by preventing sperm from coming into contact with an egg. Copper IUDs block sperm using copper, which is a highly effective spermicide. This allows for effective birth control without the use of any hormones.
The hormonal IUD works by releasing a small amount of progestin hormones into your vagina, thickening your cervical mucus to prevent sperm from entering your uterus and helping to stop your ovaries from releasing eggs.
Both types of IUD work well as forms of birth control, with an average effectiveness rate of more than 99 percent.
Just like the other forms of birth control, the IUD has advantages and disadvantages. The main advantage of an IUD is its convenience factor. With the right type of IUD, you can stop yourself from becoming pregnant through sex for up to 10 years.
This means the IUD lasts significantly longer than other long-term forms of birth control, such as the implant or injection.
Have you considered using the IUD for birth control? Our guide to birth control pills and the IUD compares these two forms of birth control in more detail, with real data on the advantages and disadvantages of each option.
Any form of birth control that uses estrogen may have some risk of affecting your blood pressure. This means the vaginal ring, the patch and all combined birth control pills have the potential to raise your blood pressure levels.
Luckily, there are plenty of safe options for you to choose from.
As always, if you have high blood pressure and want to start using birth control, the best option is to talk to your healthcare provider. They’ll be able to review your health and suggest a form of birth control that’s both effective and safe for you to use.