So you want birth control pills and have a medical illness. Is it OK?

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.

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