Contraindications for Combined Hormonal Contraceptives

Absolute Contraindications

Women with thrombogenic mutations should not use combined hormonal contraceptives due to markedly increased venous thromboembolism risk 2, 3, 4, 5
Women with a history of stroke should not use combined hormonal contraceptives 1
Women with complicated valvular heart disease should not use combined hormonal contraceptives 1
Women with peripartum cardiomyopathy with normal or mildly impaired cardiac function <6 months postpartum, or with moderately/severely impaired cardiac function at any time, should not use combined hormonal contraceptives 1
Women with multiple risk factors for arterial cardiovascular disease should not use combined hormonal contraceptives 1
Women postpartum <21 days should not use combined hormonal contraceptives due to highest VTE risk period 1
Women with current breast cancer should not use combined hormonal contraceptives 2, 3, 4, 5
Women with hepatocellular adenoma or liver malignancy should not use combined hormonal contraceptives 1, 2
Women with systemic lupus erythematosus with positive (or unknown) antiphospholipid antibodies should not use combined hormonal contraceptives 1
Women with solid organ transplantation with complications should not use combined hormonal contraceptives 1

Women with severe hypertension (systolic ≥160 mmHg or diastolic ≥100 mmHg) should not use combined hormonal contraceptives 6
Women with less severe hypertension (systolic 140-159 mmHg or diastolic 90-99 mmHg) or adequately controlled hypertension should generally not use combined hormonal contraceptives 6
Women with dyslipidemia have a 25-fold increased risk of myocardial infarction when using combined pills (OR 25, 95% CI 6-109) 6
Women with some hyperlipidemias, depending on type, severity, and presence of other cardiovascular risk factors, should not use combined hormonal contraceptives 6, 8
Women with complicated diabetes (with vascular disease, nephropathy, retinopathy, or neuropathy) should not use combined hormonal contraceptives 6
Women with migraine with aura have a 2-16 fold greater risk of stroke when using combined hormonal contraceptives 7
Women age ≥35 years who smoke ≥15 cigarettes/day should not use combined hormonal contraceptives 1
Women 21-42 days postpartum with other VTE risk factors should not use combined hormonal contraceptives 1
Women with acute or flare of viral hepatitis should not use combined hormonal contraceptives 1
Women with severe thrombocytopenia in systemic lupus erythematosus should not use combined hormonal contraceptives 1

Blood pressure measurement is required before initiating combined hormonal contraceptives 6
Routine screening is not required for glucose, lipids, liver enzymes, thrombogenic mutations, or breast examination in asymptomatic women 9, 2, 3, 4, 5, 6
The American College of Obstetricians and Gynecologists recommends copper IUD as a first-line alternative for women with contraindications to estrogen, with no metabolic effects on glucose, lipids, or blood pressure 6
The American College of Obstetricians and Gynecologists recommends levonorgestrel IUD as a alternative for women with contraindications to estrogen, with minimal systemic hormonal effects 6