Heart Health and Contraception
By: Alexandria Hill, MD
As a college freshman, I sat in a Cardiologist’s office, stunned. It was the first time I learned that the symptoms I had been experiencing for years were a result of severely diminished heart function. The significant fainting episodes that started when I was 14 years old prompted workups for eating disorders and diabetes, but no one ever thought to evaluate my heart. My hands would feel cold and clammy, I would lose the ability to hear, and then my vision would diminish until the world would go completely dark…and I would wake up on the floor.
The suggested treatment for my symptoms was to “drink pickle juice.” I was also asked repeatedly to submit urine samples to test for pregnancy, which as a non-sexually active 14-year-old seemed unnecessary.
“Your heart isn’t working properly,” the Cardiologist said. “You need to start medication immediately and come back in three months. If your heart doesn’t improve, you’ll likely be placed on a transplant list,” and that was it. That was my appointment.
As I started the medication that would ultimately determine my fate, I was informed to not become pregnant. With little guidance from the Cardiologist, I did more research and learned about the potential side effects of the prescribed cardiac medication. I sought care from my OB/GYN for further discussion. Given my struggles with acne, we reviewed options for oral contraceptive pills. As I aged, the oral contraceptives caused visual migraines and decided I needed a new option. I had another crucial conversation with my OB/GYN and together we decided to proceed with the use of an intrauterine device, commonly referred to as an IUD. I have learned from personal experience and during my medical training that access to a variety of options for contraception is imperative.
During the last 20 years I have been on and off medication to assist with the functionality of my heart. I have also spent the last 20 years of my life studying medicine and have found a home in the field of maternal-fetal medicine, which allows me to care for women with high risk pregnancies. I have found joy in educating and supporting this population. I know how it feels to have a medical condition that, if pregnant, could take your life. I have found a passion in caring for pregnant patients with cardiac disease and I try to explain the physiologic changes their body will undergo, as well as the strain that pregnancy places on their heart. Visiting with patients prior to becoming pregnant, we discuss the fact that their heart may not be able to support the stressful changes of pregnancy.
Now, having recently turned 40, I can honestly say I was not sure I would ever reach this age. I am always unsure if or when my heart function will diminish to the point of having to discuss a transplant. I have never had children and I know the struggles of having to weigh the risks of medical issues with the extreme physiologic changes of pregnancy. I can only imagine the strength it takes to enter a pregnancy, with or without medical complications, and I am honored to be an advocate for all patients during these challenging life choices.
