- Low estrogen-containing oral agents, intra-uterine devices and barrier techniques are the preferred methods of contraception for women with FH. The latter two are preferable for those older than 35 years.
- All females of childbearing age should receive advice on contraception and pre-pregnancy counselling before starting a statin and this should be reviewed annually.
- Statins and other systemically absorbed lipid regulating drugs should be discontinued 3 months prior to conception and during pregnancy and lactation.
- Women who become pregnant accidentally while on a statin could be re-assured that the likelihood of foetal complications is low.
- Controlling hypercholesterolaemia during pregnancy is particularly important in women with established CHD; it may also decrease the severity of FH in offspring who inherit the condition.
- Bile acid sequestrants are the only safe agents to control hypercholesterolaemia in pregnancy, but only modestly lower plasma LDL cholesterol levels and gastrointestinal side-effects remain a problem; colesevelam is more tolerable than older resins.
- During breastfeeding, resins could be employed to lower LDL cholesterol where indicated.
- More data is required on the outcomes of pregnancy in women with FH and on the effect of statins on the foetus in the first trimester.
- Pregnant women with heterozygous FH and established CHD, or with homozygous FH, should be considered for lipoprotein apheresis.
- Women with FH and partners of men with FH who are contemplating pregnancy should be referred to a genetic counsellor.
Menopausal hormone therapy
- The effect of menopausal hormone therapy (MHT) on risk of CHD in postmenopausal women with FH is unclear.
- On the basis of data from other populations, MHT should be avoided in women with FH, except for relief of menopausal symptoms that cannot be controlled with safe natural remedies, in which case a regimen based on cyclical transdermal oestrogen should be employed.