Contraception in Women with Hyperlipidemia and NAFLD

Introduction to Contraceptive Recommendations

Women with significant hyperlipidemia or advanced NAFLD should switch from combined hormonal contraceptives to progestin-only methods to reduce cardiovascular risk 1
The American College of Obstetricians and Gynecologists recommends careful review of metabolic profiles before using combined hormonal contraceptives in women with NAFLD 2

Combined hormonal contraceptives in women with dyslipidemia increase myocardial infarction risk (OR 25, 95% CI 6-109) 1
Women with dyslipidemia using combined hormonal contraceptives have increased risk for cardiovascular events, according to the U.S. Medical Eligibility Criteria (MEC) 3

Combined hormonal contraceptives should be avoided in women with decompensated cirrhosis due to concerns of impaired estrogen metabolism 2
Women with NAFLD require careful review of metabolic profiles before using combined hormonal contraceptives, as recommended by the American Association for the Study of Liver Diseases 2

Copper intrauterine devices (IUDs) have a failure rate <1% and are effective for up to 10 years 2
Levonorgestrel IUDs have a failure rate <1% and are effective for 3-5 years 2
Implants have the lowest failure rate (0.05%) and are effective for up to 3 years 2
Depot medroxyprogesterone acetate (DMPA) has a typical failure rate ~6% and is administered every 12 weeks 2
Progestin-only pills have a failure rate ~9% and require strict adherence to timing 2

Screening for hyperlipidemia before initiating hormonal contraceptives is not routinely necessary due to low prevalence of undiagnosed disease in women of reproductive age, according to the Centers for Disease Control and Prevention (CDC) 3
Women with mild-to-moderate hyperlipidemia who choose to continue combined hormonal contraceptives should monitor lipid profiles every 3-6 months and assess for additional cardiovascular risk factors 1

The U.S. Medical Eligibility Criteria (MEC) classifies combined hormonal contraceptive use in women with certain hyperlipidemias as category 2/3 (depending on type and severity of hyperlipidemia and presence of other cardiovascular risk factors) 3
The American College of Cardiology recommends careful consideration of cardiovascular risk factors when prescribing combined hormonal contraceptives to women with hyperlipidemia 1