Indications

• Patients desiring pregnancy in 1–2 years

  • Short-acting reversible options include OCPs, patches, and vaginal rings

  • DMPA provides relatively long protection (up to 3 months) but is not appropriate for patients who wish to regain fertility quickly.

  • Implants and IUDs can be used but may not be cost-effective

• Postpartum contraception: All contraceptive options except for combination OCPs can be considered in the postpartum period.

  • OCPs containing estrogen should not be given if breastfeeding (estrogen may reduce breast milk production and enter the milk itself).

  • Combination OCPs may only be used after 4–6 weeks postpartum.

• Symptomatic treatment in abnormal uterine bleeding

• Polycystic ovary syndrome (PCOS)

• Hyperandrogenism

  • Acne

  • Hirsutism

• Pelvic pain due to endometriosis

• Menstrual migraine

• Premenstrual dysphoric disorder (PMDD)

• Benign breast cysts

• Dysmenorrhea

• Mittelschmerz

• Cardiovascular

  • Thromboembolism

  • Coagulopathy, antiphospholipid antibodies

  • Coronary heart disease

  • Stroke

  • Arterial hypertension (> 160/95 mm Hg)

  • Heart defects

• Metabolic

  • Pronounced hypertriglyceridemia

  • Metabolic disorders of the liver

  • Insulin-dependent diabetes mellitus with vascular complications or duration greater than 20 years

• Oncologic

  • Hepatic tumors

  • Estrogen-dependent tumors (e.g., breast cancer)

• Inflammatory

  • Acute pancreatitis

  • Lupus erythematosus

  • Vasculitis

  • After herpes gestationis

• Other

  • Smoking > 35 years of age (due to significant increase in the risk of VTE)

  • Genital bleeding of unknown cause

  • Pregnancy

  • Migraine with aura

Women who smoke and are > 35 years old should not be prescribed OCPs because of increased risk of cardiovascular side effects!

• Cardiovascular

  • Superficial venous thrombosis

  • Thrombophlebitis

  • Severe varicosis

• Metabolic

  • Hypercholesterolemia

  • Morbid obesity

  • Diabetes mellitus

• Other

  • Age > 40 years

  • Migraines

  • Uterine leiomyomas (especially intracavitary)

  • Epilepsy

  • Smoking

  • Lactation (progestin-only preparations permitted): otherwise ↑ risk of thromboembolism due to estrogen excess

In the United States, laws allowing minors to consent to contraceptive health care are determined by individual states. Most states allow adolescents to receive medical care related to pregnancy prevention without parental consent.