What are the criteria for prescribing oral birth control (oral contraceptive) to patients?

From the Guidelines

Oral contraceptives should be prescribed based on a thorough medical history, including menstrual history, pregnancy intentions, and risk factors for thromboembolic disease, as well as patient preferences and reproductive life plan, as recommended by the CDC 1. When prescribing oral contraceptives, clinicians should consider the following key criteria:

• Age: generally non-smokers under age 35
• Medical history: no history of migraines with aura, venous thromboembolism, breast cancer, liver disease, uncontrolled hypertension, or cardiovascular disease
• Patient preferences: counseling on potential side effects and serious complications
• Reproductive life plan: discussion of future pregnancy intentions and contraceptive experiences The most recent and highest quality study, published in 2015, emphasizes the importance of personalized contraceptive recommendations, focusing on the patient's safety and reproductive life plan 1. Some key points to consider when prescribing oral contraceptives include:
• Obtaining clinical and social information from the patient, including medical history and sexual health assessment 1
• Counseling patients on potential side effects, including breakthrough bleeding, nausea, breast tenderness, and mood changes, as well as serious but rare complications like blood clots 1
• Discussing the importance of consistent use and the effectiveness of oral contraceptives, with typical use resulting in about 91% effectiveness compared to 99% with perfect use 1
• Advising patients that protection begins after 7 days of use and that oral contraceptives do not protect against sexually transmitted infections 1 It is also important to consider the patient's medical eligibility for a particular method, taking into account factors such as risk factors for thromboembolic disease, future pregnancy intention, and contraceptive experiences and preferences 1.

From the FDA Drug Label

Oral contraceptives must be used with caution in women with cardiovascular disease risk factors. c Cerebrovascular diseases Oral contraceptives have been shown to increase both the relative and attributable risks of cerebrovascular events (thrombotic and hemorrhagic strokes), although, in general, the risk is greatest among older (>35 years), hypertensive women who also smoke New acceptors of oral contraceptive agents should be started on preparations containing 0. 035 mg or less of estrogen. Of course, older women, as all women who take oral contraceptives, should take the lowest possible dose formulation that is effective

The criteria for prescribing oral birth control include:

• Caution in women with cardiovascular disease risk factors
• Age: older women (>35 years) should be prescribed with caution, especially if they smoke or have hypertension
• Dose: the lowest possible dose formulation that is effective, with new acceptors started on preparations containing 0.035 mg or less of estrogen
• Contraindications: women with certain conditions, such as thrombophlebitis, thromboembolic disorders, cerebral vascular or coronary artery disease, breast cancer, undagnosed abnormal genital bleeding, cholestatic jaundice of pregnancy, hepatic adenomas or carcinomas, or those receiving certain Hepatitis C drug combinations should not be prescribed oral contraceptives 2, 3, 2

From the Research

Criteria for Prescribing Oral Birth Control

The criteria for prescribing oral birth control, also known as oral contraceptives, involve several factors, including the patient's medical history, age, and lifestyle. Some of the key considerations include:

• Patient's age: Oral contraceptives are generally prescribed for women of childbearing age, typically between 17 and 40 years old 4
• Medical history: Patients with certain medical conditions, such as high blood pressure, diabetes, or a history of blood clots, may not be suitable candidates for oral contraceptives 5
• Body mass index (BMI): Patients with a high BMI may be at increased risk of side effects from oral contraceptives, such as venous thromboembolism 6
• Lifestyle: Patients who smoke or have a history of smoking may be at increased risk of side effects from oral contraceptives 7

Types of Oral Contraceptives

There are several types of oral contraceptives available, including:

• Combined oral contraceptives (COCs): These contain both estrogen and progestin, and are the most commonly prescribed type of oral contraceptive 5
• Extended-cycle pills: These contain a lower dose of estrogen and are taken for a longer period of time, typically 84 days, followed by a 7-day pill-free interval 7
• Low-dose pills: These contain a lower dose of estrogen and progestin, and are often prescribed for patients who are sensitive to the side effects of oral contraceptives 4

Efficacy and Safety

The efficacy and safety of oral contraceptives have been extensively studied, and the results show that they are highly effective in preventing pregnancy, with a Pearl Index of around 4-5 pregnancies per 100 woman-years 4, 6. However, oral contraceptives can also have side effects, such as unscheduled bleeding, nausea, and headaches, and may increase the risk of venous thromboembolism in some patients 5, 7.