Prevents the release of eggs from the ovaries (ovulation)
Effectiveness to prevent pregnancy
>99% with correct and consistent use
92% as commonly used (COC/P/CVR)
97% as commonly used (CIC)
Comments
Reduces risk of endometrial and ovarian cancer
Combined Hormonal Methods
When can a woman start CHC?
Postpartum (breastfeeding)*
If she is more than 6 months postpartum and amenorrhoeic, she can start CHC as advised for other amenorrhoeic women.
If she is more than 6 months postpartum and her menstrual cycles have returned, she can start COCs as advised for other women having menstrual cycles.
Postpartum (non-breastfeeding)*
If her menstrual cycles have not returned and she is 21 or more days postpartum, she can start CHC immediately, if it is reasonably certain that she is not pregnant. She will need to abstain from sex or use additional contraceptive protection for the next 7 days.
If her menstrual cycles have returned, she can start CHC as advised for other women having menstrual cycles.
There is no medical reason to deny sterilization to a person with this condition.
C = caution
The procedure is normally conducted in a routine setting, but with extra preparation and precautions.
D = delay
The procedure is delayed until the condition is evaluated and/or corrected. Alternative temporary methods of contraception should be provided.
S = special
The procedure should be undertaken in a setting with an experienced surgeon and staff, equipment needed to provide general anaesthesia, and other back-up medical support. For these conditions, the capacity to decide on the most appropriate procedure and anaesthesia regimen is also needed. Alternative temporary methods of contraception should be provided if referral is required or there is otherwise any delay.
Clarification: For women up to 6 weeks postpartum with other risk factors for VTE, such as immobility, transfusion at delivery, BMI > 30 kg/m2, postpartum haemorrhage, immediately post-caesarean delivery, pre-eclampsia or smoking, use of CHCs may pose an additional increased risk for VTE.
Clarification: Classification depends on accurate diagnosis of those severe headaches that are migrainous and those that are not. Any new headaches or marked changes in headaches should be evaluated. Classification is for women without any other risk factors for stroke. Risk of stroke increases with age, hypertension and smoking.
Clarification: Because there may be drug interactions between hormonal contraceptives and ARV therapy, refer to (drug interactions)
Hypertension
Category
Clarifications/Special considerations
a) History of hypertension, where blood pressure CANNOT be evaluated (including hypertension in pregnancy)
3
Clarification: For all categories of hypertension, classifications are based on the assumption that no other risk factors for cardiovascular disease exist. Read More
b) Adequately controlled hypertension, where blood pressure CAN be evaluated
3
c) Elevated blood pressure levels (properly taken measurements)
Clarification: For all categories of hypertension, classifications are based on the assumption that no other risk factors for cardiovascular disease exist. When multiple risk factors do exist, the risk of cardiovascular disease may increase substantially. A single reading of blood pressure level is not sufficient to classify a woman as hypertensive.
Clarification: Women adequately treated for hypertension are at reduced risk of acute MI and stroke as compared with untreated women. Although there are no data, COC, P, CVR or CIC users with adequately controlled and monitored hypertension should be at reduced risk of acute MI and stroke compared with untreated hypertensive COC, P, CVR or CIC users.
Clarification: If a woman is taking rifampicin, refer to the last section of this table, on drug interaction. Rifampicin is likely to decrease COC effectiveness. The extent to which P or CVR use is similar to COC use in this regard remains unclear.
No drug interactions were selected using the "Women’s characteristics" filters.
Anticonvulsants
Category
Clarifications/Special considerations
COC/P/CVR
CIC
a) Certain anticonvulsants,(phenytoin, carbamazepine, barbiturates, primidone, topiramate, oxcarbazepine)
3
2
Clarification: Although the interaction of certain anticonvulsants with COCs, P or CVR is not harmful to women, it is likely to reduce the effectiveness of COCs, P or CVR. Read More
Clarification: Although the interaction of certain anticonvulsants with COCs, P or CVR is not harmful to women, it is likely to reduce the effectiveness of COCs, P or CVR. Use of other contraceptives should be encouraged for women who are long-term users of any of these drugs. When a COC is chosen, a preparation containing a minimum of 30 µg of ethinyl estradiol (EE) should be used.
Clarification: The recommendation for lamotrigine does not apply when lamotrigine is already being taken with other drugs that strongly inhibit (such as sodium valproate) or induce (such as carbamazepine) its metabolism, since, in these cases, the moderate effect of the combined contraceptive is unlikely to be apparent.
Antimicrobial Therapy
Category
Clarifications/Special considerations
a) Broad-spectrum antibiotics
1
b) Antifungals
1
c) Antiparasitics
1
Rifampin/rifabutin
COC/P/CVR 3
CIC 2
Clarification: Although the interaction of rifampicin or rifabutin therapy with COCs, P, CVR or CICs is not harmful to women, it is likely to reduce the effectiveness of COCs, P, CVR or CICs. Use of other contraceptives should be encouraged for women who are long-term users of either of these drugs. When a COC is chosen, a preparation containing a minimum of 30 µg EE should be used.
a) Nucleoside reverse transcriptase inhibitors (NRTIs)
Clarification: Antiretroviral drugs have the potential to either decrease or increase the levels of steroid hormones in women using hormonal contraceptives.
Pharmacokinetic data suggest potential drug interactions between some antiretroviral drugs (particularly some NNRTIs and ritonavir-boosted PIs) and some hormonal contraceptives.
These interactions may reduce the effectiveness of the hormonal contraceptive.
Abacavir (ABC)
1
Tenofovir (TDF)
1
Zidovudine (AZT)
1
Lamivudine (3TC)
1
Didanosine (DDI)
1
Emtricitabine (FTC)
1
Stavudine (D4T)
1
b) Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
No other conditions were selected using the "Women’s characteristics" filters.
Adolescents
Category
Clarifications/Special considerations
Adolescents
2
Special consideration: Adolescents, In general, adolescents are eligible to use any method of contraception and must have access to a variety of contraceptive choices. Read More
Special consideration: Adolescents
In general, adolescents are eligible to use any method of contraception and must have access to a variety of contraceptive choices. Age alone does not constitute a medical reason for denying any method to adolescents. While some concerns have been expressed regarding the use of certain contraceptive methods in adolescents (e.g. the use of progestogen-only injectables by those below 18 years), these concerns must be balanced against the advantages of avoiding pregnancy. It is clear that many of the same eligibility criteria that apply to older clients apply to young people. However, some conditions (e.g. cardiovascular disorders) that may limit use of some methods in older women do not generally affect young people since these conditions are rare in this age group. Social and behavioural issues should be important considerations in the choice of contraceptive methods by adolescents. For example, in some settings, adolescents are also at increased risk for STIs, including HIV. While adolescents may choose to use any one of the contraceptive methods available in their communities, in some cases, using methods that do not require a daily regimen may be more appropriate. Adolescents, married or unmarried, have also been shown to be less tolerant of side-effects and therefore have high discontinuation rates. Method choice may also be influenced by factors such as sporadic patterns of intercourse and the need to conceal sexual activity and contraceptive use. For instance, sexually active adolescents who are unmarried have very different needs from those who are married and want to postpone, space or limit pregnancy. Expanding the number of method choices offered can lead to improved satisfaction, increased acceptance and increased prevalence of contraceptive use. Proper education and counselling both before and at the time of method selection can help adolescents address their specific problems and make informed and voluntary decisions. Every effort should be made to prevent service and method cost from limiting the options available.
