The birth control pill, patch and ring contain estrogen and progestin. Of those two hormones, estrogen carries more risk – especially to the cardiovascular system. Which women can’t take estrogen?

Women with the following conditions should not take estrogen:

• Migraine with neurologic symptoms or aura
• Smoking over 15 cigarettes/day (only among women over age 35)
• Current breast cancer
• Uncontrolled hypertension or hypertension with vascular disease
• Ischemic heart disease (pulmonary hypertension, risk for atrial fibrillation, history of bacterial endocarditis)
• Moderate/severe cardiomyopathy
• Stroke
• Deep venous thrombosis (current or past), or high risk of thrombosis (such as known thrombophilia, active/metastatic cancer, major surgery with prolonged immobilization)
• Severe liver disease
• Solid organ transplantation with complication (graft failure, rejection, cardiac allograft vasculopathy)
• Lupus with positive antiphospolipid antibody

Estrogen-containing contraceptive methods should never be used for women with one or more of the conditions above. However, most of these women can safely use the progestin-only pill, progestin injection, progestin implant, a progestin IUD, or a copper IUD.

Use the Medical Eligibility for Initiating Contraception Chart to determine the safest and most appropriate method for your patient given her medical conditions and personal preferences.

We appreciate your feedback! Please write us at pearls@reproductiveaccess.org

Helpful Resources

Medical Eligibility for Initiating Contraception

Birth Control Choices Fact Sheet

Sources

1. CDC information:

Tepper N, Curtis KM, Jamieson DJ, Marchbanks PA. Update to CDC’s U.S. medical eligibility criteria for contraceptive use, 2010: revised recommendations for the use of contraceptive methods during the postpartum period. Center for Disease Control and Prevention (CDC). MMWR Morb Mortal Wkly Rep 2011;60:878-83.

Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion. U.S. Medical Eligibility Criteria for Contraceptive Use, 2010. Center for Disease Control and Prevention (CDC). MMWR Morb Mortal Wkly Rep June 18, 2010;59(RR04;1-6).

2. World Health Organization Info:

World Health Organization. Medical Eligibility Criteria for Contraceptive Use. 4th ed. Geneva: World Health Organization, 2009.

Pharma-free

The Reproductive Health Access Project does not accept funding from pharmaceutical companies. We do not promote specific brands of medication or contraception. The information in the Contraceptive Pearls is unbiased, based on science alone.