A Tough Pill to Swallow: Contraindications to COC Use

The following is a reference list of underlying medical conditions that, if present, may increase a woman's risk of experiencing medical complications as a result of combined oral contraceptive (COC) use. This list was gleaned from the Merck Manual, a common reference that can be found in any doctor's office or hospital unit in the country.

Contraindications to Combination Oral Contraceptive Use
Degree	Condition
Absolute	·      Abnormal uterine bleeding with an undiagnosed cause ·      Diabetes mellitus (or other disorders) with vascular complications ·      History of estrogen-dependent cancer, coronary artery disease, hepatic adenoma, idiopathic recurrent jaundice of pregnancy, stroke, thromboembolism, deep venous thrombosis, MI, or active SLE (because risk of cardiovascular sequelae is increased) ·      Hypertension if uncontrolled ·      Immobilization of a lower extremity if prolonged ·      Liver disorders if active ·      Major surgery for 1 month after (and 1 month before if elective) ·      Pregnancy ·      Renal insufficiency ·      Smoking after age 35 ·      Triglyceride levels > 250 mg/dL
Relative	·      Amenorrhea with an undiagnosed cause ·      Cigarette smoking if heavy in women < 35 ·      Depression ·      Diabetes (treated) ·      Family history of blood clots ·      Fibroids ·      History of liver disorders with recovery ·      Hypertension (treated) ·      Migraines with neurologic symptoms ·      Obesity ·      Precancerous cervical lesions (treated) ·      Premenstrual syndrome ·      Seizure disorder (drug-treated) ·      Varicose veins

Allow me to take a moment to define some terms and abbreviations. First of all, the categories absolute and relative essentially refer to the level of caution a provider ought to observe when prescribing COCs to a patient. Any of the medical conditions in the absolute list are absolute contraindications - patients with these conditions should not take the Pill. Medical conditions in the relative list are relative contraindications, meaning that patients with these conditions may have an increased risk for complications relative to the general population and should consider other alternatives, though use of the Pill is ultimately permissible. As for some of the terms and abbreviations within the list...

• Diabetes mellitus is type II diabetes (usually adult on-set)
• Hepatic adenomas are benign liver tumors
• MI is myocardial infarction (a fancy clinical term for heart attack)
• Thromboembolism and Deep venous thrombosis are blood clots
• SLE is systemic lupus erythematosus (commonly known as Lupus)
• Hypertension is chronic high blood pressure
• Renal insufficiency is chronic kidney failure
• Amenhorrea is the chronic absence of menstrual bleeding

Please feel free to leave a comment should you have any other questions or concerns about this list. I'd be happy to clarify any other terms or abbreviations, though medical questions concerning your relative risks and decisions about your medications should be directed to your physician, since I am not (yet), in fact, a doctor ;] 

It is absolutely critical, when evaluating the relative risk you assume in taking COCs, that you be made aware of the underlying medical conditions that may augment that risk. The statistics that I've offered in other posts in this series refer to the baseline, general population risk - having any of the contraindicated conditions (relative or absolute) immediately puts a patient at a higher risk for complications. 

Stay tuned for the next topic in this series on the health risks associated with oral contraceptive use, and if you're just joining us, catch up on previous posts:

• Introduction
• Vascular Complications
• The Pill as an Abortifacient (not part of this series, but a relevant read)

***UPDATE: Catch the next post in this series on Infertility