What considerations should I take into account when prescribing combined hormonal contraception to women with comorbidities such as hypertension or di

When prescribing combined hormonal contraception (CHC) to women with comorbidities such as hypertension or diabetes, several important considerations must be taken into account to ensure safety and efficacy.

• Hypertension: CHC is not recommended if blood pressure is consistently ≥160/100 mmHg due to unacceptable health risks (UKMEC 4). For adequately controlled hypertension with systolic BP 140–159 mmHg or diastolic BP 90–99 mmHg, CHC is generally not recommended as risks outweigh benefits (UKMEC 3). In these cases, alternative hormonal or intrauterine methods with lower risk profiles should be considered (UKMEC 1 or 2) ¹.
• Women with hypertension and vascular disease should not use CHC due to unacceptable health risks (UKMEC 4), and progestogen-only injectables are also not recommended (UKMEC 3) ¹.
• Diabetes: Women with diabetes can generally use oral contraceptives, but the choice should be based on individual preferences and risk factors, including cardiovascular risk ⁴.
• In women with multiple cardiovascular risk factors (e.g., smoking, diabetes, hypertension, obesity, dyslipidaemia), CHC and progestogen-only injectables are not recommended as risks outweigh benefits (UKMEC 3) ¹.
• For women with a history of gestational diabetes, all hormonal and intrauterine methods can be used without restriction (UKMEC 1) ¹.
• Consider the impact of BMI, as CHC is not recommended in women with BMI ≥35 kg/m2 due to increased risks, and efficacy of some methods may be reduced in women over 90 kg ¹.
• Monitor for other contraindications such as history of venous thromboembolism (VTE), migraine with aura, and smoking status, as these also influence CHC suitability ¹,².

In summary, for women with hypertension or diabetes, CHC should be prescribed cautiously, avoiding use in uncontrolled hypertension or presence of vascular disease, and considering alternative contraceptive methods when cardiovascular risk factors are present. Individual risk assessment and shared decision-making are essential.