Stopping birth control due to high blood pressure requires immediate professional guidance. Hormonal contraceptives, especially those containing estrogen, can affect the body’s vascular system, increasing blood pressure and elevating the risk of serious cardiovascular events. Consult a healthcare provider before making any changes, as stopping abruptly without a plan risks unintended pregnancy.
How Hormonal Birth Control Affects Blood Pressure
The primary concern involves the synthetic estrogen component, typically ethinyl estradiol, found in combination pills, patches, and rings. Estrogen stimulates the liver to produce more angiotensinogen, a precursor protein in the Renin-Angiotensin-Aldosterone System (RAAS). This ultimately leads to higher levels of angiotensin II, a potent hormone that constricts blood vessels and promotes the retention of sodium and water. The resulting vasoconstriction and increased fluid volume are the main mechanisms that can cause or exacerbate hypertension.
While this effect is usually modest, it can be more pronounced in some individuals. Progestin-only methods, such as the minipill or hormonal intrauterine devices (IUDs), do not contain estrogen and are not associated with RAAS activation, carrying a much lower risk of affecting blood pressure.
When High Blood Pressure Becomes a Contraindication
The severity of hypertension dictates the safety of continued combined hormonal contraception use. According to medical eligibility criteria, a systolic blood pressure (SBP) between 140–159 mmHg or a diastolic blood pressure (DBP) between 90–99 mmHg is a relative contraindication. This means the method is generally not recommended unless other options are unacceptable.
For women with severe hypertension, defined as an SBP of 160 mmHg or higher or a DBP of 100 mmHg or higher, combined hormonal methods are an absolute contraindication and must not be used. Using these hormones with severely elevated blood pressure significantly increases the risk of serious cardiovascular events, such as stroke or heart attack. Even controlled hypertension is typically a contraindication due to the potential for hormones to destabilize blood pressure.
Essential Steps Before Changing Contraception
Stopping a contraceptive method abruptly without consulting a doctor is discouraged, as it results in the loss of pregnancy protection. The risk of an unintended pregnancy, especially in the context of high blood pressure, can introduce its own set of health complications. The first step is to monitor your blood pressure consistently and accurately, documenting readings to share with your healthcare provider.
You should schedule an urgent appointment to discuss your hypertension diagnosis and contraceptive use with a physician, who can then formulate a safe transition plan. If the high blood pressure is determined to be a direct effect of the medication, the blood pressure will begin to return to pre-treatment levels within two to three months after stopping the combined hormonal contraceptive. Your provider may choose to switch you immediately to a safer contraceptive alternative or start antihypertensive medication to stabilize your blood pressure. Continue your current regimen until your doctor advises otherwise, unless you experience symptoms of a hypertensive crisis, which requires emergency medical care.
Safe Contraception Alternatives for High Blood Pressure
Numerous contraceptive options are safe for individuals with controlled or uncontrolled hypertension because they do not contain estrogen. The safest option, which has no restrictions based on blood pressure, is the non-hormonal copper intrauterine device (IUD). This device is highly effective and works without systemic hormonal involvement.
Progestin-only hormonal methods are also generally safe, as they avoid the RAAS-activating effects of estrogen. These include the progestin-only pill (mini-pill), the levonorgestrel-releasing hormonal IUD, and the subdermal implant. Since the progestin is delivered systemically or locally, these methods do not carry the same cardiovascular risks as combined methods. Barrier methods, such as condoms, diaphragms, and cervical caps, are non-hormonal and pose no risk to blood pressure, though they have a higher typical failure rate than long-acting reversible contraceptives.