Women and heart failure
For women with heart failure, there are specific times in their life that may require specific advice and attention.
Reproductive years (age about 15-50 years)
It is important to consider the potential impact of a pregnancy on the heart. This will help you decide about whether to pursue a pregnancy and the type of contraception that may be suitable for you. It is important to think about this, as it will help you avoiding an unplanned pregnancy.
Pregnancy
Pregnancy puts additional strain on the body, causing many changes that help the foetus grow and prepare the body for delivery. These changes include an increase in blood volume 30-50%, an increase in heart rate and changes to blood pressure. Tissues in the body start to relax to prepare for delivery. At the time of delivery, there are even more changes to blood volume and blood pressure. After delivery, it takes time for the body to return to the way it was pre-pregnancy. Women with normal heart function may feel burdened by these profound alterations. You may have noticed your friends who are pregnant can become breathless, tired, and have palpitations.
What does this mean for a pregnant women with heart failure? As you will know there is a spectrum of heart failure ranging from mild to severe. This website cannot offer individualised advice, but we can give you a little of what you need to know. If the heart is already compromised in its function, all these changes in pregnancy, especially the increase in blood volume, increase the risk of further changes to the heart. Some women will tolerate these changes well. For some women, however, these changes might be serious and could affect heart function, heart rhythm, and may impact how well the baby grows or when it is delivered. For this reason, all pregnant women with a history of heart failure should be regularly examined by a team specializing in heart disease in pregnancy. This allows changes to be detected at an early stage.
Some medication that is frequently given to improve heart failure (e.g. ACEi, ARB, sacubitril/valsartan, MRA, SGLT2i) can be harmful to a foetus. If you are considering pregnancy, speak to your cardiologist about what should be changed in the medication list. You then also will receive advice about potential risks, if these tablets are stopped for pregnancy. It is often possible for women with a heart condition to breastfeed. The decision depends on your preference, how stable your heart is, and also the prescribed medications.
For these reasons, if you are considering a pregnancy, speak to your cardiologist. The course of pregnancy up to the delivery and any medication changes will be monitored as needed. Before delivery you will receive advice on contraception.
Contraception
There are several contraceptive options for women with heart failure. Your decision on what contraceptive is best for you will depend on:
- Desire to avoid a pregnancy
- Pregnancy risk
- Frequency of sexual activity
- Safety of contraception in the context of health conditions
- Family history
- Religious and cultural considerations
- Current medication
- Menorrhagia
- Recent pregnancy and breastfeeding
- Avoidance of sexually transmitted diseases
- Adherence
- Side-effects
Contraception can carry some risk. It is important that risk is balanced against the risk of a pregnancy. Generally, a healthcare professional would advise women with heart failure to avoid contraceptives containing oestrogen. Intra-uterine devices or injectable contraceptive methods are preferred over oral contraception. However, it is important you get advice from someone who understands your heart condition, any other medical conditions you may have and medications you are taking.
Assisted reproductive therapy (ART)
Some women may require the assistance of reproductive therapies to conceive. Some men and women, who have an inherited condition that is responsible for their heart failure, may chose ART to support implantation of an embryo without the inherited condition. This involves pre-implantation genetic testing. For people with heart failure, it is possible to have ART. However, it is essential that you discuss this with your cardiologist who can provide advice and refer you to an appropriate ART service for further assessment.
ART can have some risks that need to be assessed based on your heart condition. The ART team and your cardiologist will also consider not just the risk of ART, but also the risk of the pregnancy for you.
Menstruation
Sometimes women with heart failure may also be prescribed drugs to prevent blood from clotting (anti-platelet drugs or anticoagulants). These drugs can make your period heavier. If you experience this, speak to a healthcare professional. They may check bloods and tests for anaemia. There are options to reduce menstrual bleeding: so please speak to your healthcare professional for advice before you stop your medications.
Before and during menstruation it can be common for women to feel bloated, gain weight, and some may feel light-headed, especially if there is heavy bleeding. As a woman with heart failure, it is important to understand what is normal for you at this time to help you assess weight gain in the context of your period. Some women struggle with light-headedness and some may need adjustment of their heart failure medication. If you are struggling to balance your heart failure medications during your period, please speak to your heart failure specialist. It is important not to stop your heart failure tablets for long periods of time.
Menopause (age 45-52 years)
Menopause occurs when a woman has not had a period for at least 12 months. This is caused by changes in hormone levels. Symptoms of menopause such a hot flushes, difficulty sleeping, low mood, memory problems, weight changes and reduced sex drive are common and can have a big impact on a woman’s quality of life.
During menopause and in the post-menopausal phase, women can develop or present with signs and symptoms of heart disease. General advice about menopause and the heart, as well as how to reduce risk of acquired heart disease can be found here.
For women with heart failure, there are some specific considerations. Managing the symptoms of menopause to help you support quality of life is important and you do have options for menopause treatment. Speak to your primary care physician or cardiologist for further advice. They will take into consideration your own heart health, family history of heart disease and other factors to make an individualised treatment plan.
