Contraception for adults and adolescents with congenital cardiac disease

The number of women with congenital cardiac disease, who mature into adulth ood is increasing. Unfortunately, there are no prospective data published a bout the relative risk of different forms of contraception for these patien ts. Most women with congenital cardiac disease can safely use oral contrace tives, especially low-estrogen combination or progestin-only preparations, with the exception of those, who are at particular risk because of thrombem bolic complications (especially in cyanosis, pulmonary hypertension, Eisenm enger reaction, rhythm disturbances), fluid retention (especially in reduce d ventricular function and congestive heart failure), arterial hypertension (important in coarctation), infectious complications (endocarditis) or hyp erlipidemia. Oral contraceptives should be avoided in patients at increased risk for thrombembolic events. Intrauterine devices are very effective, ha ve no metabolic side effects and merely cary a small risk of endocarditis. Newer devices containing progesterone only may put the patients at a still smaller risk. Contraceptive subdermal implants (e.g. levonorgestrel) are us ed with good results in the United States for patients with contraindicatio ns to estrogen-containing oral contraceptives and may well become more wide ly accepted in patients in Germany in the coming years. Barrier methods can be used, but have a higher failure rate, which may be inacceptable in pati ents at risk (e.g. Eisenmenger's). Especially in Eisenmenger's, permanent s terilisation should be advised.