title: Usefulness of progesterone-only components for contraception in patients with congenital heart disease.
abstract: The objective of the study is to report the contraceptive methods used by patients with congenital heart disease (CHD) before referral to a specific preconception clinic and evaluate safety and treatment adherence of the alternative contraception method, progesterone-only component (PC), offered. Contraceptive methods in the CHD population reported included estrogen-progesterone combined contraceptives (EPCC), despite the potential risk for thromboembolism. PC has been suggested as an alternative, but, no information on its use has been reported. Retrospective analysis was performed of all patients (n = 237) referred to the preconception clinic of an adult CHD center. Thirty-three percent of patients had used EPCC in the past; 3.8% had had thromboembolic events during its use. Current contraception consisted of barrier methods in 58% of patients, EPCC in 18%, and PC in 1.3%; 21.7% of patients were not using any contraception. PC was offered as an alternative in 146 patients; 73% of patients agreed to start the treatment. At a median follow-up of 1 year, 73% of patients who started PC maintained the treatment. Gynecologic side effects were reported in 25% of patients, with no cardiovascular effects. In conclusion, a significant proportion of patients with CHD were former users of EPCC, although some had formal contraindications, and the rate of PC use before referral to the preconception clinic was low. After being offered as an alternative treatment, the use of PC in its various forms was extensive, with no thrombogenic side effects and an acceptable rate of gynecologic side effects being reported.
authors.affiliation: Adult Congenital Heart Disease Unit, Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain. apijuan@vhebron.net
authors.forename: Antonia
authors.initials: A
authors.lastname: Pijuan-Domènech
authors.forename: Francesc
authors.initials: F
authors.lastname: Baró-Mariné
authors.forename: Mireia
authors.initials: M
authors.lastname: Rojas-Torrijos
authors.forename: Laura
authors.initials: L
authors.lastname: Dos-Subirà
authors.forename: Valle
authors.initials: V
authors.lastname: Pedrosa-Del Moral
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Subirana-Domènech
authors.forename: Maria
authors.initials: M
authors.lastname: Goya-Canino
authors.forename: Luis
authors.initials: L
authors.lastname: Cabero-Roura
authors.forename: David
authors.initials: D
authors.lastname: Garcia-Dorado
authors.forename: Jaume
authors.initials: J
authors.lastname: Casaldàliga-Ferrer
mesh_terms: D000293:Adolescent; D000328:Adult; D003277:Contraceptives, Oral, Combined / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000150:complications*; D006801:Humans; D008875:Middle Aged; D011374:Progesterone / Q000008:administration & dosage* / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D013927:Thrombosis / Q000139:chemically induced*
chemical_list: D003277:Contraceptives, Oral, Combined; D011374:Progesterone