Cystic Fibrosis: Contraception

Women with CF are able to get pregnant. An unplanned pregnancy can have a big effect on your health. Some CF medications are “teratogenic,” meaning that they can cause birth defects, so it is very important to prevent pregnancy if you are taking these medications. Whether or not you have CF, if you have sex, you definitely need to think about how to prevent getting pregnant and how to protect yourself from sexually transmitted infections (STIs). There are many different types of contraceptives or birth control you and/or your partner can choose from. Hormonal contraceptives can also be used for other reasons such as irregular periods, menstrual cramps, or acne. Some women report that using a hormonal form of contraception may help with CF symptoms that are worse during their menstrual cycle.

Women with CF have special things to consider when choosing contraception.

What do I need to know about contraception and CF?

There are many different types of contraceptives. They vary in how effective they are at preventing pregnancy, how much they cost, how easy they are to use, and whether they also protect against STIs.  The table below gives some key facts about contraceptives and CF. All of these methods have different success and failure rates.

  • All women, with or without CF, should think about the pros and cons of each contraceptive method, before deciding on the right one for them.
  • It’s important to choose a contraceptive method that is effective, but also fits with what you want and need. It’s a good idea to talk to your partner, parent(s), guardian, or a trusted adult, and your CF provider if you are thinking about having a sexual relationship. Talking about contraception and getting all of your questions answered will help you figure out the best contraceptive choice for you.
MethodSuccess Rate with Typical UseSummaryKey facts for CF
Hormonal implants

 

 

99%
  • Long-term method of birth control (protects against pregnancy for 3 years after insertion–it can be removed by a health care provider when you want to or you can wait for 3 years when it’s time for a change of implant)
  • May cause light or no menstrual periods or irregular menses
  • Requires minor surgery to insert the tiny rod(s) underneath the skin and to remove the device
  • Safe and effective for use by women with CF
  • Lumacaftor/ivacaftor (Orkambi), may make this method less effective. If you are taking Orkambi, non-hormonal contraceptive methods are recommended.
Intra-uterine Device (IUD)99%
  • Long-term method of birth control that protects against pregnancy as long as it is in place in your uterus (anywhere from 3 to 10 years depending on the type of IUD)
  • Needs to be inserted by a healthcare provider
  • Hormonal IUDs lessen menstrual flow and can be used to treat heavy periods
  • Copper IUDs can have side effects such as menstrual cramping, longer and/or heavier menstrual periods, and spotting between menstrual periods
  • Can fall out or can rarely puncture the uterus
  • Can be removed at any time and you can get pregnant right after removal
  • Lumacaftor/ivacaftor (Orkambi), may make hormonal IUDs less effective. If you are taking Orkambi, non-hormonal contraceptive methods are recommended.
  • Copper IUDs are not affected by Orkambi and are a very effective form of contraception.
Tubal Ligation (Female Sterilization)99%
  • Permanent (although it is possible to undo sterilization with major surgery, it’s not always successful)
  • Requires minor surgery
  • Only should be used by women who are absolutely sure that they do not want any or any more children
  • This method of birth control is permanent.
  • Essure, a form of tubal ligation in which coils are placed in the fallopian tubes, may not be effective if you are taking steroids such as prednisone.
Depo-Provera ® Hormonal Injection94%
  • Each injection provides 3 months of protection against pregnancy
  • Need to see your health care provider every 3 months for an injection
  • Many women stop getting their menstrual period while getting injections. (This is not a medical problem and menstrual periods usually return 6-18 months after you stop taking injections)
  • Generally NOT recommended in CF as it may cause loss of bone density and increase the risk of low bone mass, such as osteopenia or osteoporosis, in women with CF.
  • Lumacaftor/ivacaftor (Orkambi) may make hormonal contraceptives less effective. If you are taking Orkambi, non-hormonal contraceptive methods are recommended.
Birth Control Pills91%

 

Perfect Use

99%

  • Makes menstrual periods more regular and lighter
  • Decreases menstrual cramps and acne
  • Need to remember to take every day at the same time
  • Birth control pills have to be taken at the same time every day and may add on to your CF care routine.
  • If you are pancreatic insufficient, not taking your enzymes as directed can make birth control pills less effective. If you have major issues with malabsorption, birth control pills may also not be as effective.
  • Lumacaftor/ivacaftor (Orkambi), may make hormonal contraceptives less effective. If you are taking Orkambi, non-hormonal contraceptive methods are recommended.
  • Some antibiotics (i.e., rifampin) and other drugs used to treat HIV, certain anti-seizure and antifungal medicine, and some herbal medicine will make hormonal contraceptive methods less effective. A second contraceptive method, such as condoms, should be used to prevent pregnancy while you are taking these medications.
  • Hormonal birth control with estrogen may increase your risk of blood clots and may not be a good option if you have CF-related liver disease or have an implanted device such as a port.
Hormone Patch (Ortho-Evra) (Xulane)91%

 

Perfect Use

99%

  • Makes menstrual periods more regular and lighter
  • Decreases menstrual cramps and acne
  • Lumacaftor/ivacaftor (Orkambi) may make hormonal contraceptives less effective. If you are taking Orkambi, non-hormonal contraceptive methods are recommended.
  • Some antibiotics (i.e., rifampin) and other drugs used to treat HIV, certain anti-seizure and antifungal medicine, and some herbal medicine will make hormonal contraceptive methods less effective. A second contraceptive method, such as condoms, should be used to prevent pregnancy while you are taking these medications.
  • Hormonal birth control with estrogen may increase your risk of blood clots and may not be a good option if you have CF-related liver disease or have an implanted device such as a port.
Vaginal Hormonal Ring (Nuva-Ring)91%

 

Perfect Use

99%

  • Makes menstrual periods more regular and lighter
  • Decreases menstrual cramps and acne
  • Lumacaftor/ivacaftor (Orkambi), makes hormonal contraceptives less effective. If you are taking Orkambi, other contraceptive methods are recommended.
  • Some antibiotics (i.e., rifampin) and other drugs used to treat HIV, certain anti-seizure and antifungal medicine, and some herbal medicine will make hormonal contraceptive methods less effective. A second contraceptive method, such as condoms, should be used to prevent pregnancy while you are taking these medications.
  • Hormonal birth control with estrogen may increase your risk of blood clots and may not be a good option if you have CF-related liver disease or have an implanted device such as a port.
Emergency Contraception (EC) 89%
  • Backup method of birth control for preventing pregnancy after unprotected sex.
  • Even though it’s commonly called the “morning-after pill,” there is both a pill and an intrauterine device that can be used within 5 days (120 hours) of unprotected intercourse.
  • The sooner you take it, the more likely it will work.
  • Side effects are usually mild and may include nausea and irregular periods.
  • This is a good back-up method to always have available if you have any issues with your regular contraception.
  • In the United States any woman can get EC at most pharmacies without a prescription. If you want to use an intrauterine device as EC, you will need to be seen at a clinic to have the device inserted.
  • Safe and effective for all women with CF.
  • If you are pancreatic insufficient not taking your enzymes as directed can make the pill form of EC less effective.
  • You can use the EC website to find a health care provider or pharmacy if you have questions about emergency contraception or talk with your PCP, gynecologist, or CF team.
* fertility awareness based methods (FAB), and the lactational amenorrhea method (LAM) are not known to be affected by CF.

Barrier methods can also be used to protect against pregnancy. Types of barrier methods include the male condom, female condom, diaphragm, cervical cap, spermicide, and contraceptive sponge. With typical use, the effectiveness of these methods ranges from 72-88%.  CF is not known to affect barrier methods of contraception.

Does contraception protect against sexually transmitted infections (STIs)? 

It’s very important to remember that most contraceptives do not protect against STIs. Apart from practicing abstinence or not having sex, only certain barrier methods, such as condoms used every time you have sex, can lower your risk of getting STIs! Types of barrier methods that protect against STIs include the male condom, female condom, and dental dams (for mouth to genital or anal contact).

What about CF medicines and contraception?

  • If you are taking lumacaftor/ivacaftor (Orkambi), it is recommended that you do NOT use a hormonal method of contraception. You can use a copper intra-uterine device (Paragard IUD), barrier methods, or abstinence.  The method you choose should be very effective because the effects of Orkambi during pregnancy have not been studied.
  • Common CF medications, such as Cayston, Tobi, Pulmozyme, and Hypertonic Saline, are not known to interact with any forms of contraception.
  • If you are participating in a study for a new medication for CF, you may have additional rules around the type of contraception you can take.
When you have CF, there is a lot to consider when choosing the best contraceptive method for you. If you are or planning to become sexually active, make an appointment with your CF team and/or a women’s health doctor (such as a gynecologist or an adolescent medicine specialist) to talk about your birth control options.

Here are some specific talking points and tips that may help you discuss contraception with your CF team:

  1. Tell your team that you are having sex or are thinking of having sex and that you are interested in starting birth control.

Example: “I am thinking about/have started having sex with my partner.  I want to protect myself from getting pregnant and from STIs.”

  1. You can also be direct and just say that you need a form of contraception.

Example: “I need a form of birth control/contraception.”

  1. Remind your CF team if you take Orkambi or are often prescribed any inhaled or oral antibiotics (especially rifampin). These medications can have interactions with certain types of birth control.

Example: “I take Orkambi. /You often prescribe me rifampin for my exacerbations./etc.  I know this medication may have an interaction with certain types of birth control. What do you recommend?”

There is a lot of information to remember and consider when choosing a type of birth control. You can print out this guide or have your provider pull up the webpage during your visit. More information on CF and contraception can be found on the Cystic Fibrosis Foundation (CFF) website: www.cff.org.