From the Guidelines
Oral contraceptive pills (OCPs) should not be used in patients with severe and uncontrolled hypertension, ongoing hepatic dysfunction, complicated valvular heart disease, migraines with aura or focal neurologic symptoms, thromboembolism or thrombophilia, complications of diabetes, and complicated solid organ transplantation due to increased health risks. The contraindications for OCPs are primarily focused on conditions that may increase the risk of thromboembolism, cardiovascular events, or worsen existing medical conditions 1. Some of the key contraindications include:
- Severe and uncontrolled hypertension (systolic pressure ≥160 mm Hg or diastolic pressure ≥100 mm Hg)
- Ongoing hepatic dysfunction
- Complicated valvular heart disease
- Migraines with aura or focal neurologic symptoms
- Thromboembolism or thrombophilia
- Complications of diabetes (e.g., nephropathy, retinopathy, neuropathy, or other vascular disease)
- Complicated solid organ transplantation Additionally, certain medications like rifampin, some anticonvulsants, and certain HIV medications can reduce OCP effectiveness through enzyme induction 1. It's essential to consider these contraindications when prescribing OCPs to ensure the safest and most effective use of these medications. The most recent and highest quality study 1 provides the most up-to-date information on the contraindications for OCPs, and healthcare providers should consult this study when making decisions about OCP use. In general, the benefits and risks of OCP use should be carefully weighed, and alternative contraceptive methods should be considered for patients with contraindications to OCPs. Overall, the use of OCPs requires careful consideration of the potential risks and benefits, and healthcare providers should prioritize the safety and well-being of their patients when making decisions about OCP use.
From the FDA Drug Label
Oral contraceptives should not be used in women who have any of the following conditions: Thrombophlebitis or thromboembolic disorders A past history of deep vein thrombophlebitis or thromboembolic disorders Cerebral vascular or coronary artery disease (current or history) Valvular heart disease with complications Severe hypertension Diabetes with vascular involvement Headaches with focal neurological symptoms Major surgery with prolonged immobilization Known or suspected carcinoma of the breast or personal history of breast cancer Carcinoma of the endometrium or other known or suspected estrogen-dependent neoplasia Undiagnosed abnormal genital bleeding Cholestatic jaundice of pregnancy or jaundice with prior pill use Hepatic adenomas or carcinomas Known or suspected pregnancy Hypersensitivity to any component of this product
The contraindications for Oral Contraceptive Pills (OCPs) include:
- Thrombophboembolic disorders
- Cerebral vascular or coronary artery disease
- Severe hypertension
- Diabetes with vascular involvement
- Known or suspected carcinoma of the breast or endometrium
- Undiagnosed abnormal genital bleeding
- Hepatic adenomas or carcinomas
- Known or suspected pregnancy
- Hypersensitivity to any component of the product 2
From the Research
Contraindications for Oral Contraceptive Pills (OCPs)
The following are contraindications for Oral Contraceptive Pills (OCPs):
- Arterial hypertension 3
- History of coronary or cerebrovascular conditions 3
- Deep vein thrombosis 3, 4, 5, 6
- Hypercholesterolaemia exceeding 3 g/l 3
- Hypertriglyceridaemia exceeding 3 g/l 3
- Unusually severe headache on a combined oral contraceptive 3
- Prolonged immobilisation 3
- Inherited thrombophilia 4, 6
- Personal history of venous thromboembolism 4, 6
- Obesity 4, 5
Special Considerations
Certain conditions may not be absolute contraindications, but require careful consideration and monitoring:
- Moderate hypercholesterolaemia or hypertriglyceridaemia 3
- Well-controlled insulin-dependent diabetes 3
- Uncomplicated cardiac valve disease 3
- Migraine not worsened by a combined oral contraceptive 3
- Varicose veins or a family history of deep vein thrombosis 3, 4
- Women who are fully anticoagulated 6
Risk Factors
The following factors increase the risk of venous thromboembolism: