Most contraindications to oral contraceptives (OC) are due to the estrogen
component in the pill. Clearly, there are women for whom OCs should not
be prescribed. These include women who have a history of migraines with
aura due to the increased risk of stroke. Women with uncontrolled high
blood pressure or smokers older than age 35 should not be prescribed OCs
because of increased heart disease risk. Caution should be used when initiating
combined OCs in women who already have elevated blood pressure.
OCs are contraindicated in several other groups of women. These include
diabetics with end-organ damage (kidney, eye, vascular); a personal history
of breast cancer or estrogen-dependent tumor; active liver disease; a
history of blood clots in veins. Women with mild high cholesterol who
do not have other cardiovascular risk factors can be prescribed OCs if
their low-density lipoprotein cholesterol is less than 160. Combined OCs
are also contraindicated in breast-feeding women who are within 6 weeks
of delivery (Progesterone only pill OK).
Potential side effects of OCs should be discussed with patients considering
OC use. The most common side effects include nausea, headaches, breast
tenderness, and breakthrough bleeding which often resolve in first few
months. A more serious, but uncommon side effect of OC use is a small
increase in the risk of venous blood clots compared to women who do not
use OCs; this risk may be higher in obese women. This increase is much
lower than the risk blood clots associated with pregnancy.
Unplanned pregnancy in women with medical illnesses like those described
above can be disastrous for both mother and child. Other
contraceptives may be better suited for these women. Nevertheless, contraception, while
not perfect nor risk free, allows time to optimize medical conditions
so as to reduce impact on pregnancy or avoid it altogether if that is
what a woman desires.