Muristek
To the Editor A recent Review discussed the importance of an evidence-based approach and careful consideration of various factors when selecting optimal contraception. The authors identified oral contraceptive pills as the most commonly used reversible contraceptive and discussed some aspects of effectiveness and risks of these medications. Regarding cardiovascular risks, while the authors listed untreated hypertension as a contraindication for combined hormonal contraceptives (CHCs), they did not discuss that CHCs are US Medical Eligibility Criteria for Contraceptive Use (MEC) category 3 or 4 regardless of blood pressure control. These recommendations from the Centers for Disease Control and Prevention classify CHCs as a method for which the risks mostly or entirely outweigh potential benefits for all women with hypertension. In addition, prior studies have shown that individuals with hypertension taking CHCs are at higher risk of acute myocardial infarction than those with hypertension who do not use CHCs. Furthermore, women taking CHCs without hypertension at baseline had a higher risk of developing hypertension compared with women who never used CHCs in 4 years of follow-up. Additionally, 2 cross-sectional studies showed that women with hypertension who used CHCs had higher systolic and diastolic blood pressure compared with those who did not use CHCs. In contrast, progestin-only pills and long-acting contraceptive methods, which are MEC category 1 or 2, provide a safe alternative for women with hypertension, regardless of blood pressure control. Long-acting progestin-only or copper intrauterine devices and subdermal implants are also more effective contraceptives than CHCs, with less than 1 pregnancy per 100 individuals per year.
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