Combined Oral Contraceptive Pills

Combined Oral Contraceptive Pills


Are there times when the combined oral contraceptive pill should be prescribed only with special caution?

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Are there times when the combined oral contraceptive pill should be prescribed only with special caution?

Yes, there are times when a patient has medical problems such that the combined oral contraceptive pill can be prescribed but only with special caution. More careful monitoring is required. Examples are:

  • moderately elevated blood pressure (hypertension) requiring medication (patients with a history of high blood pressure in pregnancy can be given the combined oral contraceptive pill but again the blood pressure should be checked more frequently).

  • obesity (greater than 50% above ideal weight for height) is a reason for caution. Calorie control and exercise should be encouraged with a view to ensuring weight loss.
  • hormones may, on occasion, aggravate depression.
  • sickle cell disease (an inherited cause of anaemia found generally in people of Afro-Caribbean origin); this was regarded as a contraindication for the combined oral contraceptive pill as there is an increased risk of thrombosis; some authorities now suggest that the combined oral contraceptive pill can be given with caution. It may be prudent to discontinue the combined oral contraceptive pill during any episodes of immobilisation.

  • some medical conditions when they are mild but not if they are severe. Examples are diabetes, systemic lupus (SLE), Crohn's disease and renal disease.

    Varicose vein problems are not a contraindication for the combined oral contraceptive pill. Varicose veins are more frequently found in association with obesity and this would be a reason for caution. The pill should be stopped if you need injection treatment.

    When a woman has a medical problem that may be affected by the combined oral contraceptive pill, the doctors involved in her care will usually liaise to ensure consistency of advice. Ultimately it is for the doctors caring for the woman to provide her with the information that she requires to make an informed choice.


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