Summary
Women with many medical conditions need to plan their families with special care. For such women, the risk of complications with particular contraceptive methods is increased.
Women with severe hypertension, a previous myocardial infarction or venous thromboembolism, or cerebrovascular stroke have a significant risk of problems in pregnancy, and should avoid the combined pill. The combined pill may increase the risk of cardiovascular disease in patients with diabetes mellitus and may worsen the severity of migrainous headaches in susceptible patients. Women with active hepatitis should wait for liver function tests to normalise before becoming pregnant or starting the combined pill or injectable progestogen. Control of epilepsy may deteriorate with use of the combined pill; this is probably because of the risk of drug interactions. Similarly, contraceptive control may also fail in women receiving rifampicin (rifampin) concurrently with contraceptive steroids.
Intrauterine contraceptive devices should not be used in women who have experienced previous episodes of pelvic inflammatory disease, or with previous malignancy of the genital tract until complete cure is likely.
Other conditions which may appear, become more common or worsen when the combined pill is prescribed include hepatic adenoma, gall bladder disease, ulcerative colitis, alopecia, hirsutism and acne. Some of these conditions are potentially hazardous to the woman’s health, in which case combined pill use should be stopped. If the condition is unchanged then the combined pill may sometimes be reintroduced with caution.
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References
Filshie M, Guillebaud J. Contraception — science and practice, 2nd ed., Butterworths, London, 1991
Fraser IS. Systemic hormonal contraception by non-oral roots. In Filshie & Guillebaud (Eds) Contraception — science and practice, pp. 109–125, Butterworths, London, 1989
Fraser IS, Weisberg E. A comprehensive review of injectable contraception with special emphasis on depot medroxyprogesterone acetate. Medical Journal of Australia 1 (suppl.): 1–19, 1981
Gillmer MDG. Metabolic effects of combined oral contraceptives. In Filshie & Guillebaud (Eds) Contraception — science and practice, pp. 11–38, Butterworths, London, 1989
Guillebaud J. Practical prescribing of the combined oral contraceptive pill. In Filshie & Guillebaud (Eds) Contraception — science and practice, pp. 69–93, Butterworths, London, 1989
Gomel V. Microsurgical reversal of female sterilisation: a reappraisal. Fertility and Sterility 33: 587, 1980
Guillebaud J. The pill. Oxford University Press, Oxford, 1987
Harlap S, Kost K, Forrest JD. Preventing pregnancy, protecting health: a new look at birth control choices in the United States, Alan Guttmacher Institute, New York, 1991
Hull MGR, Gordon C, Beard RW. Organisation and results of a pregnancy termination service in a National Health Service hospital. Journal of Obstetrics and Gynaecology of the British Commonwealth 81: 173–181, 1974
Kelaghan J, Rubin GL, Ory HW, Layde PM. Barrier-method contraceptives and pelvic inflammatory disease. Journal of the American Medical Association 248: 184, 1982
Khoo SK, Correy JF. Contraception and the ‘high risk’ woman. Medical Journal of Australia 1: 60, 1981
Lincoln R. Smoking and reproduction. International Family Planning Perspectives 12: 22–26, 1986
Mishell DR. Non-contraceptive health benefits of oral steroidal contraceptives. American Journal of Obstetrics and Gynecology 142: 809, 1982
Ory HW. The non-contraceptive health benefits from oral contraceptive use. Family Planning Perspectives 14: 182, 1982
Ory HW, Forrest JD, Lincoln R. Making choices: evaluating the health risks and benefits of birth control methods, Alan Guttmacher Institute, New York, 1983
Rakers H. New generation of monophasic oral contraceptives. In Keller (Ed.) Contraception into the next decade, pp. 13–24, Parthenon Press, Carnforth, 1988
Tatum HJ, Connell EB. A decade of intrauterine contraception, 1976–1986. Fertility and Sterility 46: 173, 1986
Tietze C, Bongaarts J, Schearer B. Mortality associated with the control of fertility. Family Planning Perspectives 8: 6–14, 1976
Vessey MP. Female hormones and vascular disease — an epidemiological overview. British Journal of Family Planning 6 (suppl.): 1–12, 1980
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Fraser, I.S. Contraceptive Choice for Women with ‘Risk Factors’. Drug-Safety 8, 271–279 (1993). https://doi.org/10.2165/00002018-199308040-00002
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DOI: https://doi.org/10.2165/00002018-199308040-00002