Family Planning

Using Clinical Judgment in Special CasesUsually, a woman with any of the conditions listed below should not useCOCs. In special circumstances, however, when other, more appropriatemethods are not available or acceptable to her, a qualified provider whocan carefully assess a specific woman’s condition and situation may decidethat she can use COCs. The provider needs to consider the severity of hercondition and, for most conditions, whether she will have access to follow-up.óóóóóóóóóóóóóóNot breastfeeding and less than 3 weeks since giving birthPrimarily breastfeeding between 6 weeks and 6 months since giving birthAge 35 or older and smokes fewer than 15 cigarettes a dayHigh blood pressure (systolic blood pressure between 140 and 159 mmHg or diastolic blood pressure between 90 and 99 mm Hg)Controlled high blood pressure, where continuing evaluation is possibleHistory of high blood pressure, where blood pressure cannot be taken(including pregnancy-related high blood pressure)Mild cirrhosis of the liver or history of jaundice while using COCs in the pastGall bladder disease (current or medically treated)Age 35 or older and has migraine headaches without auraYounger than age 35 and has migraine headaches without aura that havedeveloped or have gotten worse while using COCsHad breast cancer more than 5 years ago, and it has not returnedTaking barbiturates, carbamazepine, oxcarbazepine, phenytoin, primidone,topiramate, or rifampicin. A backup contraceptive method should also beused because these medications reduce the effectiveness of COCs.Diabetes for more than 20 years or damage to arteries, vision, kidneys, ornervous system caused by diabetesMultiple risk factors for arterial cardiovascular disease such as older age,smoking, diabetes, and high blood pressure1Combined Oral ContraceptivesCombined Oral Contraceptives forWomen With HIVóóWomen who are infected with HIV, have AIDS, or are onantiretroviral (ARV) therapy can safely use COCs.Urge these women to use condoms along with COCs. Usedconsistently and correctly, condoms help prevent transmission ofHIV and other STIs. Condoms also provide extra contraceptiveprotection for women on ARV therapy. It is not certain whetherARV medications reduce the effectiveness of COCs.Who Can and Cannot Use Combined Oral Contraceptives