Use of Hormonal Contraception in Women With Coexisting Medical Conditions

Publication Date: February 1, 2019
Last Updated: March 14, 2022

Summary of Recommendations

The following recommendations are based on good and consistent scientific evidence.

  • Women with certain conditions associated with VTE should be counseled for nonhormonal or progestin-only contraceptives.
  • Gynecologic care providers should not perform routine screening for familial thrombotic disorders ating combined hormonal contraceptives.
  • Use of combined hormonal contraceptives is contraindicated in women with known familial thrombophilias (USMEC category 4). Progestin-only methods and LNG-IUDs are acceptable alternatives for individuals with known thrombogenic mutations (USMEC category 2).
  • Women with SLE should be tested for anti-phospholipid antibodies before initiating hormonal contraception. Combined hormonal contraception is contraindicated in women with SLE and positive antiphospholipid antibodies (USMEC category 4).
  • Regardless of breastfeeding status, combined hor-monal contraceptives are contraindicated during the first 21 days after giving birth because of the risk of VTE (USMEC category 4); therefore, health care providers should advise against initiating combined hormonal contraceptives during this time. Venous thromboembolism risk decreases postpartum day 21–42, although this risk continues to outweigh contraceptive benefits (USMEC category 3) in women with additional risk factors for VTE.
  • At the time of contraceptive initiation, the diagnosis of migraine with or without aura should be carefully considered in all women who present with a history of headache.
  • Combined hormonal contraceptives can be used in women who have migraine without aura and no other risk factors for stroke (USMEC category 2). Estrogen-containing contraceptives are not recommended for women who have migraine with aura because of the increased risk of stroke (USMEC category 4).
  • Women with blood pressure below 140/90 mm Hg may use any hormonal contraceptive method. In women with hypertension of systolic 140–159 mm Hg or diastolic 90–99 mm Hg, combined hormonal contraceptives should not be used unless no other method is appropriate for or acceptable to the patient (USMEC category 3). Women with hypertension of systolic 160 mm Hg or greater or diastolic 100 mg Hg or greater or with vascular disease should not use combined hormonal contraceptives (USMEC category 4).
  • For women with uncomplicated insulin or non-insulin dependent diabetes, no methods of hormonal contraception are contraindicated based on available data (USMEC category 2). However, for women with diabetes of more than 20 years of duration or evidence of microvascular disease (retinopathy, nephropathy, or neuropathy), combined hormonal contraceptives are contraindicated (USMEC category 3 or 4 depending on the severity of the condition).



Use of Hormonal Contraception in Women With Coexisting Medical Conditions

Authoring Organization