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Eisenmenger Syndrome: Why Contraception in these Women?

Claudia Tomas, Isabel Lobo Antunes, Berta Lopez and Agueda Vieira

Introduction: Einsenmenger syndrome (ES) appears when chronic pulmonary hypertension arising from a left-toright intra-cardiac shunt leads to a reversal of this shunt and, inevitably, cyanosis. Currently, treatment is aimed at improving patient survival and functional capacity. After ES develops, transplantation is the final therapeutic option. Pregnancy is absolutely contraindicated, with a reported rate of mortality ranging from 30-50%; therefore, a safe and appropriate method of contraception should be imperative for these patients. Hysteroscopic sterilization is the ideal method, however, for a patient who declines nonreversible methods, other options are progestin-only contraception with depot medroxyprogesterone acetate injections, etonogestrel implant or an intrauterine device (IUD). A coppercontaining IUD is not recommended but a Levonogestrel IUD is an option for mildly cyanotic women who are at low risk of acquiring a sexually transmitted disease and is the preferred method because it reduces menstrual flow by 40-50% and may induce amenorrhoea. Menorrhagia is a common problem in women with cyanotic heart disease and its suppression is often helpful.

Objectives: The authors intend to review the literature and report a case of a 47 year-old woman with ES, with severe menorrhagia and consequent haemodynamic repercussion.

Conclusions: In these women, contraception should be used not only to prevent an unintended pregnancy but also to control menorrhagia in order to avoid anaemia