4. You’re Planning a Pregnancy or Changing Birth Control Methods
If you’re thinking about starting a family or changing birth control methods, loop in your HAE care team first. Pregnancy and certain hormonal contraceptives can affect attack frequency and treatment options.
Because estrogen is a known HAE trigger, birth control methods that contain this hormone, including combined oral contraceptives, patches, and rings, are generally avoided. Your care team may recommend a progestin-only or nonhormonal option instead, Banerji says. Talk with your allergist before starting, stopping, or changing birth control so you can make the decision with your HAE treatment in mind.
“Pregnancy has an unpredictable effect on HAE, and attack frequency can increase, decrease, or stay the same. It can even vary trimester to trimester within the same pregnancy,” Banerji says. That unpredictability is one reason to review your medications with your specialist before trying to conceive.
For example, danazol, an older medication used to prevent HAE attacks, is an androgen and should not be used during pregnancy. If you take it, your allergist can help you switch to a safer treatment before becoming pregnant. Plasma-derived C1 inhibitor concentrate, such as Berinert, “has the longest safety track record and is generally considered a first-line option during pregnancy and breastfeeding,” Banerji says.
Attack patterns may change again after delivery, with some people experiencing more frequent episodes while breastfeeding. Staying in touch with your HAE treatment team before pregnancy and after delivery can help ensure that your treatment remains safe and effective throughout these life transitions.
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