Family Planning with a Chronic Condition

Today’s contraceptives are reliable and accessible, and for women whose baseline health is good, various products are available to meet their expectations.

However, women who have chronic medical conditions have unique concerns. Pregnancy may place them or their babies at risk even though therapeutic advances allow many medically compromised women to navigate pregnancy safely. Contraception for women who have chronic conditions is a World Health Organization (WHO) priority. WHO’s most recent program to address contraception in medically-compromised women is described in an article in Best Practice & Research, Clinical Obstetrics and Gynaecology.

WHO has created guidelines for contraception in specific maternal diseases via its Medical Eligibility Criteria (WHO-MEC) program, which recognizes that family planning/reproductive health programs will vary based on each country’s national health policies, needs, priorities, and resources. In fact, several developed countries, including the United States, have expanded on these tenants and modified them to incorporate aspects of their health systems.

The WHO-MEC system recommends contraceptive methods for each medical condition in 4 categories. The reviewers cover 8 chronic conditions: cardiac disease, hypertension, diabetes/obesity/metabolic syndrome, venous thromboembolism, migraine headache, epilepsy, autoimmune conditions, HIV/AIDS, and other chronic conditions in general. Many gynecologic problems are addressed individually — endometrial polyps, endometriois, and fibroids — in the “other” category.

The WHO guideline summarizes risks associated with specific contraceptive methods in women with these conditions. The general approach advocates assessing the patient’s disease severity; determining pregnancy risks; identifying the patient’s contraceptive needs, and the expected duration of need; examining the guideline; and considering consultation with a specialist. Ultimately, clinicians need to discuss options with the patient and allow her to select a contraceptive method.

The article calls attention to the complexities of contraceptive decisions for women who have chronic conditions and stresses the need to time pregnancy so that the woman is capable of facing its physiologic and pathological changes and has access to adequate medical care.