Contraception for Women with Endocrine Abnormalities

Abstract

Endocrine abnormalities are linked with the reproductive system and the interplay of endogenous and exogenous hormones must be considered prior to contraceptive initiation. The most common endocrine abnormalities in reproductive-age women include hyperthyroidism, hypothyroidism, and polycystic ovary syndrome (PCOS). There are no studies of contraceptive use in women with hyperthyroidism, goiter, or hypothyroidism. Based on studies of contraceptive use in euthyroid women, current evidence suggests that all contraceptive methods can be used without restriction in women with these conditions. There are also no contraceptive methods that are contraindicated due to PCOS itself, and the USMEC does not address PCOS specifically. However, considerations that should be involved in contraceptive method selection depend on the features of the syndrome exhibited, including abnormal menstrual cycles, the effect of unopposed estrogen on the endometrium, androgenic symptoms, or obesity and insulin resistance. Overall, the benefits of contraceptive use outweigh the risks in most patients, but some women with PCOS and metabolic syndrome may have risk factors that should be considered prior to initiation or that require increased surveillance after initiation.