As World Heart Day approaches on September 29, the Agir pour le Cœur des Femmes Foundation is raising awareness about the prescription of estrogen-progestin contraception for women with multiple cardiovascular risk factors.
Cardiovascular disease remains a major health concern for women. According to the French women’s health advocacy group Agir pour le Cœur des Femmes (Act for Women’s Hearts), 200 women die from it every day in France. And the latest data from the National Observatory of Women’s Health highlights another area of concern: contraception for women already at high cardiovascular risk.
In this high-risk population, 40.7% of combined oral contraceptive prescriptions are deemed inappropriate based solely on cardiovascular risk factors . This figure rises to 59.8% when certain family histories of cardiovascular disease are also taken into account. The analysis here focuses on 1,062 records of women aged 15 to 55 years whose type of contraception was recorded, with a mean age of 38.9 years.
Estrogen-progestin contraception: what risk factors should raise concern?
Combined contraception, also called estrogen-progestin contraception, combines a synthetic estrogen and a progestin. It can take the form of a pill, a vaginal ring, or a skin patch . For some women with multiple cardiovascular risk factors, it may be contraindicated or require the use of another method.
Professor Geneviève Plu-Bureau, gynecologist and epidemiologist at Cochin-Port-Royal Hospital and president of the Scientific Council of Agir pour le Cœur des Femmes (Act for Women’s Hearts), outlines the main factors identified. “The most frequent risk factors noted in this high-risk cardiovascular cohort are hypertension, a first-degree family history of cardiovascular disease, and the combination of age (over 35) and smoking or obesity .”
Figures from the Observatory show that 9 out of 10 women in this population have at least two cardiovascular risk factors, and that nearly two-thirds report warning symptoms such as palpitations, shortness of breath, chest pain, or dizziness. Hence the importance of regularly reassessing contraception based on changes in health status. “It is also essential to inform women about the different methods of contraception and their potential contraindications ,” emphasizes Professor Geneviève Plu-Bureau.
When a prescription is first issued, a lengthy consultation may be covered by health insurance to assess any potential risk factors. The Foundation also recommends checking with each renewal that no new cardiovascular contraindications have emerged.
Stress and mental health: another cardiovascular risk factor not to be overlooked
Cardiovascular risk is not solely dependent on biological factors such as hypertension or weight. Data from the Observatory shows that 66.2% of women screened report excessive stress and/or have already been treated for depression.
Another analysis conducted on 20,000 women screened in the Women’s Heart Bus also found a state of stress or depression in 60% of them, regardless of their social level.
And after a cardiovascular event, 40% of women may develop depression or post-traumatic stress disorder . According to the Foundation for Action for Women’s Heart Health, prevention must take into account all of these dimensions, with cardiovascular, gynecological, and also psychological monitoring when necessary.
