There are multiple factors to consider in choosing the best contraceptive method for Karen. She smokes half a packet of cigarettes every day, her systolic pressure indicates stage one high blood pressure, has heavy and painful menses, and her family has a history of cardiovascular diseases as well as cancer. Current evidence does not recommend using oral contraceptives, contraceptive injections, and vaginal rings, as well as a patch for women who smoke. Studies indicate that cigarette smoking among women who use birth control pills significantly increases the chances of developing cardiovascular problems. For smokers, birth control pills pose a major risk for health ranging from blood clots to strokes or even heart attacks. Most of the cardiovascular side effects associated with birth control pills are severe in women who smoke. Existing evidence indicates that exogenous estrogen, which is found in combined pills, causes an increase in both diastolic and systolic pressures because of water and sodium retention in the body (Allen et al., 2017). This is especially common in hypertensive women.
According to (Allen et al., 2017), there is a significant elevation in blood pressure after using a combined birth control pill in hypertensive and normotensive women. However, it is not yet confirmed if the combined pills cause hypertension, or they reveal high blood pressure that was already in existence and would later appear. A combined pill has both estrogen and progesterone. These two hormones stop ovulation hence prevent pregnancy. In addition, they make the mucus in the cervix area thick hence hard for sperms to pass through. Also, both estrogen and progesterone thin the womb lining, making it difficult for a fertilized egg to implant itself in the womb. Estrogen is known to increase the risk of developing blood clots (Allen et al., 2017). However, studies on progestin indicate that it has no significant effect on blood pressure and can be used by smokers.
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Hormonal birth control methods such as pills, skin patches, intrauterine devices, and Depo-Provera injections reduce bleeding and pain during menstruation ( Doumouchtsis et al., 2016). However, Intrauterine devices and Depo-Provera can prolong menstrual flow. Progesterone prevents the growth of the lining on the womb prior to menstruation, and this reduces bleeding during menses. The mini-pill, which contains progestin-only, is also known to reduce menstrual flow and make it lighter or even make it stop in some cases. Studies also indicate that hormonal IUDs that contain progestin are effective in addressing the heavy menses problem.
Some studies have found that women who have never used IUDs have a reduced risk of developing cervical cancer ( Cortessis et al., 2018) . Since her mother has a history of cervical cancer, a progestin-only IUD is not recommended for Karen to reduce any risk for cervical cancer. Considering that Karen has an increased risk for cardiovascular conditions such as stroke and heart attack because of her blood pressure and family history, it is not recommended that she uses a birth control method that contains both estrogen and progesterone. Also, considering the fact that her blood pressure is above the normal range, it is not advisable to recommend a method that has both estrogen and progesterone. Smoking half a packet of cigarettes daily indicates that Karen is a heavy smoker. When contraceptive methods that contain progesterone and estrogen are used, a heart attack or stroke may occur. Therefore, a progestin-only pill would be recommended for Karen. Progestin does not pose risks to cardiovascular problems, and it is researchers have found it suitable for women who smoke. A progestin-only pill would also help improve her menses by making them lighter and reduce the pain associated with menstruation. Also, progestin pills can be used for individuals of any
References
Allen, A. M., Weinberger, A. H., Wetherill, R. R., Howe, C. L., & McKee, S. A. (2017). Oral contraceptives and cigarette smoking: A review of the literature and future directions. Nicotine & Tobacco Research , 21 (5), 592-601. doi:10.1093/ntr/ntx258
Cortessis, V. K., Barrett, M., Wade, N. B., Enebish, T., Perrigo, J. L., Tobin, J., … McKean-Cowdin, R. (2018). Intrauterine device use and cervical cancer risk. Obstetrical & Gynecological Survey , 73 (3), 156-158. doi:10.1097/ogx.0000000000000535
Doumouchtsis, S. K., Arulkumaran, S., & Mahmood, T. (2016). Abnormal menses and bleeding. Oxford Medicine Online . doi:10.1093/med/9780199651382.003.0010
