Absolute Contraindications to Alesse (Ethinyl Estradiol/Levonorgestrel)
Alesse and all combined oral contraceptives containing ethinyl estradiol are absolutely contraindicated in women with current or history of thromboembolic disease, uncontrolled hypertension, hepatic disease, breast cancer, undiagnosed abnormal genital bleeding, and migraines with focal neurologic symptoms. 1
Cardiovascular and Thromboembolic Contraindications
- Active or history of deep vein thrombosis (DVT) or pulmonary embolism (PE) is an absolute contraindication to all combined estrogen-progestin contraceptives 2, 1
- Cerebrovascular disease or coronary artery disease, including history of stroke or myocardial infarction, prohibits use 3, 4, 2, 1
- Known thrombophilias (factor V Leiden, antiphospholipid antibody syndrome, protein C/S deficiency, antithrombin III deficiency) are absolute contraindications 4, 2
- Severe uncontrolled hypertension (systolic ≥160 mmHg or diastolic ≥100 mmHg) prohibits combined oral contraceptive use 3, 4, 2, 1
- Smoking in women ≥35 years of age is an absolute contraindication due to substantially increased stroke and cardiovascular risk 5, 2
Neurologic Contraindications
- Migraines with aura or focal neurologic symptoms at any age absolutely contraindicate combined oral contraceptives 3, 4, 5, 2
- Any migraine headaches in women ≥35 years (with or without aura) are contraindicated 2
Hepatic Contraindications
- Active hepatic dysfunction or hepatic disease prohibits use 3, 4, 2, 1
- Hepatic adenomas or carcinomas (benign or malignant hepatic tumors) are absolute contraindications 2, 1
- Cholestatic jaundice of pregnancy or jaundice with prior pill use prohibits combined oral contraceptive use 2, 1
- Concomitant use with Hepatitis C drug combinations containing ombitasvir/paritaprevir/ritonavir (with or without dasabuvir) is contraindicated due to risk of ALT elevations 2, 1
Malignancy Contraindications
- Current diagnosis or history of breast cancer (which may be hormone-sensitive) absolutely prohibits use 2, 1
- Carcinoma of the endometrium or other estrogen/progestin-sensitive cancers are contraindications 2
Other Absolute Contraindications
- Pregnancy is an absolute contraindication (Category X) 5, 2, 1
- Undiagnosed abnormal genital or uterine bleeding prohibits initiation until diagnosis is established 2, 1
- Complicated valvular heart disease or thrombogenic rhythm diseases are contraindications 2
- Surgery with prolonged immobilization requires discontinuation 2
- Renal dysfunction and adrenal insufficiency are listed as contraindications 2
Special Populations Requiring Alternative Contraception
- Antiphospholipid antibody-positive patients (with or without clinical complications) must avoid all estrogen-containing contraceptives due to markedly increased thrombosis risk; strongly recommend progestin-only methods or IUDs instead 6
- SLE patients with moderate or severe disease activity (including nephritis) should use progestin-only or IUD contraceptives rather than combined estrogen-progestin methods 6
- Diabetes with complications (nephropathy, retinopathy, neuropathy, or other vascular disease) prohibits combined oral contraceptive use 3, 4
- Complicated solid organ transplantation is a contraindication 3, 4