Cardiometabolic, Glycaemic, and Metabolic Safety of Hormonal Contraceptives in Women with Medical Conditions: A Systematic Review.

Abstract

Hormonal contraceptives are widely used, however, their safety among women with underlying medical conditions, particularly cardiometabolic disorders such as hypertension, diabetes mellitus, and obesity, remains a key clinical concern. As the prevalence of these conditions increases globally among women of reproductive age, updated evidence is required to support risk-stratified contraceptive decision-making. To evaluate the cardiometabolic, glycaemic, and metabolic safety of hormonal contraceptive use among women with underlying medical conditions. A systematic review was conducted in accordance with PRISMA 2020 guidelines. PubMed, Web of Science, and Scopus were searched for English-language human studies published between 2015 and 2025. Eligible studies included randomized controlled trials, cohort studies, case-control studies, and comparative observational designs. Data were synthesized descriptively due to heterogeneity in study populations, exposure characteristics, and outcome measures. Methodological limitations included English-language restriction, lack of protocol registration, and inconsistent reporting of contraceptive dose, formulation, and duration. A total of 44 studies were included, with combined estrogen-containing contraceptives being the most frequently evaluated (79.5%, 35/44). Progestin-only methods 18.2% (8/44); long-acting reversible contraceptives 18.2% (8/44); mixed hormonal exposure 13.6% (6/44). Hypertension was the most commonly reported comorbidity, followed by diabetes mellitus and obesity. Lipid and metabolic parameters were reported in 31.8% (14/44) of studies, blood pressure outcomes in 25.0% (11/44), and glycaemic outcomes in 15.9% (7/44). No notable short-term changes were observed however, modest increases in systolic blood pressure, triglycerides, and insulin resistance were identified in selected high-risk populations. Hormonal contraceptive use shows no consistent short-term cardiometabolic risk; however, modest adverse changes in high-risk populations requires risk-stratified use and further standardized longitudinal research.