Can birth control cause high blood pressure?

First things first: blood pressure is the pressure your blood exerts on the walls of your arteries as it travels through your body. High blood pressure can increase the risk of heart attack, stroke, and other high-risk conditions, so it’s something that should be managed with lifestyle changes and/or medication. However, about 25% of reproductive-age women in the U.S. have hypertension, and of that, less than half are aware that they have the condition. [1] 

Since high blood pressure is generally asymptomatic, your healthcare provider will probably want to test your blood pressure levels before prescribing a hormonal birth control method. This is because some forms of hormonal birth control can actually increase your blood pressure, so if it’s already high, they would not want your birth control medication to contribute to it. In fact, safety concerns regarding the pill’s effect on blood pressure were raised when this option first became available. This led to lower doses, but concerns persisted as the years went on and more research was done in this area. [2]

What’s the link between blood pressure and birth control?

While more research is needed to understand the exact chemical mechanism that links birth control and blood pressure, studies have shown that certain types of birth control, particularly birth control with synthetic forms of estrogen, can in fact raise blood pressure.

The leading theory as to why estrogen-dominant forms of contraception cause high blood pressure is that the synthetic estrogen found in these medications may:

• Increase vascular resistance by affecting how your body controls fluids, making it more difficult for blood to flow through your body
• Increase inflammation in the body
• Lead to abnormal cholesterol levels

All of these factors can directly or indirectly contribute to high blood pressure, or make pre-existing high blood pressure worse. On top of this, synthetic estrogen can increase the chances of blood clots which in turn can lead to serious health problems such as stroke or heart attack. [1] All this can be dangerous because while high blood pressure often doesn’t come with any symptoms, it can damage essential organs in the body. Luckily, there are ways to manage the condition in a healthy way. [3] More on this later.

Why does blood pressure matter when choosing birth control?

So, if high blood pressure doesn’t have any symptoms, why does it matter when it comes to choosing birth control? High blood pressure is a factor you and your healthcare provider should address because using a birth control that may increase your blood pressure puts you at higher risk for a heart attack and/or stroke, along with other potential complications based on many factors, including your age, whether you’re pregnant or not, and your medical history. 

High blood pressure is medically referred to as “hypertension.” The American College of Cardiology in partnership with the European Society of Hypertension, makes the following classifications when discussing blood pressure levels [6]:

These numbers are essentially how much pressure your blood is exerting on the walls of the arteries as your heart pumps the blood throughout your body. The lower the number, the less tension/pressure there is in your arteries.

How is blood pressure measured?

To test for these numbers, your healthcare provider will usually put a cuff on your arm that inflates and temporarily stops blood flow. As it deflates and blood starts to flow again, the cuff measures how hard your blood pushes against the walls of your arteries and providesk a number within the ranges outlined above.[5] You might find it helpful to know that you can also measure your blood pressure at home with one of these devices.

Depending on your situation and risk factors, your healthcare provider may recommend repeat visits where they continue monitoring your blood pressure for the first few weeks or months after starting hormonal birth control. If they see an increase in blood pressure, they may recommend switching birth control methods. [1]

Basically, if you have optimal, normal, or elevated blood pressure, you may not want to take a medication that would tip you over the edge into hypertension territory. If you already have any grade hypertension, taking birth control may worsen the condition and further increase your risk of heart attack or stroke. These conditions are not to be taken lightly, especially when there are plenty of birth control methods without estrogen or non-hormonal birth control options available to you that likely won’t affect blood pressure at all. [1]

Which birth control methods can raise blood pressure?

It’s thought that hormonal birth control methods that contain synthetic forms of the hormone estrogen are the most likely culprits of high blood pressure from birth control [1]. The forms of birth control that contain synthetic estrogen that may raise blood pressure include:

• Combined oral contraceptives (the pill)
• The birth control patch
• The vaginal ring

With this in mind, healthcare professionals generally recommend staying away from these forms of birth control if you have elevated or high blood pressure, especially if you are over the age of 35. If you’re under the age of 35 with well-managed blood pressure, you may be able to use one of these methods, but your healthcare provider will want to closely monitor your blood pressure to make sure it doesn't increase[1].

It’s worth noting that the birth control shot (also called the depo shot) doesn’t have estrogen, but it has been known to increase cholesterol for some people which may also contribute to cardiovascular issues. Your healthcare professional might recommend switching birth control methods if they think the shot is high risk for you. [1,4]

Which birth control methods don’t contain estrogen?

Luckily, there are a range of birth control methods that don’t contain estrogen and therefore shouldn’t raise your blood pressure (again, we can’t emphasize enough how important it is to speak to your healthcare provider about your unique medical history and what would be best for you). Let’s go through some of the completely non-hormonal options first, then we’ll cover the hormonal ones.

Non-hormonal birth control without estrogen:

• Natural Cycles: The first FDA Cleared birth control app, this temperature-based method identifies your fertile days so you can choose to use protection or abstain from sex when there is any risk of pregnancy.
• Cervical cap: A small piece of silicone shaped like a cup that is inserted into the vagina before sex to prevent sperm from reaching egg cells.
• Condoms (male and female): A barrier method either worn on the penis or inserted into the vagina before sex to prevent pregnancy.
• Copper IUD (intrauterine devices): A T-shaped device made out of copper that sits inside the uterus for several years, it changes the way that sperm move so that they can’t reach the egg, thus preventing pregnancy by stopping the implantation process.
• Diaphragm: A circular dome-shaped silicone barrier that is inserted into the vagina before sex.
• Spermicide: Usually available as a foam, gel, paste, or suppository, spermicide blocks the entrance to the cervix and also makes it more difficult for sperm to travel. [8]

Hormonal birth control methods without estrogen:

• The hormonal IUD: A T-shaped device (similar to the copper IUD) that’s made out of plastic and releases a synthetic version of the hormone progesterone into the body.
• The implant: Commonly referred to as Nexplanon, the most popular brand name of the implant in the U.S., the implant is a small plastic rod often inserted into the arm that releases progesterone into the bloodstream.
• The mini pill: Also called the progestin-only pill or PoP, this is a daily pill that releases a synthetic version of progesterone into the body. 
• The depo shot: An injectable dose of progestin you only need to get every 12-13 weeks, or about 4 times per year.

All of the hormonal options listed here use forms of the hormone progesterone rather than estrogen to help prevent pregnancy in a number of ways. It thickens cervical mucus, making it more difficult for sperm to travel. It also thins the lining of the uterus, making implantation harder. It also may prevent ovulation or make it irregular. 

Fun fact: one form of synthetic progesterone called drospirenone found in certain birth controls can actually decrease mean blood pressure in women with mild hypertension. [1]

What’s the best birth control if you have high blood pressure?

Overall, there are a range of birth control options available to you if you want to avoid estrogen due to high blood pressure or any other reason. The next step is to explore the pros and cons of all the options, think about what would suit your lifestyle, and speak with your healthcare provider about what the best option is for you.

Should I stop taking birth control if my blood pressure is high?

Always consult your healthcare provider if your body is giving you signals that something isn’t right for you, or if you feel “off” when beginning a new medication or birth control. If they see that your blood pressure has increased since starting hormonal birth control and there are no other likely causes of the increase, they will most likely recommend stopping the hormonal birth control, switching methods, or considering other options. [7]

Can I take birth control while taking blood pressure medication?

Common blood pressure control medications like Metoprolol generally will not interfere with your birth control, so as long as you’ve talked with your healthcare provider about all of your medicines and their interactions, it’s generally safe to take both at the same time. [7]

How does high blood pressure affect the risk of complications during pregnancy?

It’s always important to keep blood pressure under control in the normal/optimal zone, and this is especially important during pregnancy. High blood pressure during pregnancy can lead to a number of complications for both mother and baby:

• Mother is more likely to experience preterm delivery, the need for labor induction, and preeclampsia along with the elevated risk of heart attack and stroke. 
• Baby may have a low birth weight — it’s difficult for the proper amount of oxygen and nutrients to get to the baby if the mother has high blood pressure. [5]

The good news is that high blood pressure is preventable and treatable, usually with lifestyle adjustments for the Elevated to Grade 1 range, and medication in addition to lifestyle change for higher levels. [3] And if it seems like the high blood pressure is caused by hormonal birth control, you have options for switching and getting your levels back in check.

Skip the side effects with Natural Cycles

Blood pressure is just one of the side effects linked to hormonal birth control. If you want to explore switching to a birth control method with zero hormones and zero side effects, why not see if Natural Cycles works for you? If and when the time is right, you can also easily transition to the “Plan Pregnancy” setting within Natural Cycles whenever you’re ready to start trying to get pregnant. Learn more about Natural Cycles here.