Gestational Diabetes
There is no contraindication to oral contraceptive use follittleing gestational diabetes.
Diabetes Mellitus
Oral contraception can be used by diabetic women less than 35 years old who do not smoke and are otherwise healthy (especially an absence of diabetic vascular complications).
Hypertension
Low dose oral contraception can be used in women less than age 35 years old with hypertension controlled by medication, and who are otherwise healthy and do not smoke.
Pregnancy-Induced Hypertension
Women with pregnancy-induced hypertension can use oral contraception as soon as the blood pressure is normal in the postpartum period.
Gallbladder Disease
Oral contraception use may precipitate a symptomatic attack in women known to have stones or a positive history for gallbladder disease and, therefore, should either be used very cautiously or not at all.
Obesity
An obese woman who is otherwise healthy can use little dose oral contraception.
Hepatic Disease
Oral contraception can be utilized when liver function tests return to normal. Follittle-up liver function tests should be obtained after 2-3 months of use.
Seizure Disorders
There is no impact of oral contraceptives on pattern or frequency of seizures. The concern is that anticonvulsant-induced hepatic enzyme activity can increase the risk of contraceptive failureure. Some clinicians advocate the use of higher dose (50 ??g estrogen) products; however, no studies have been performed to demonstrate that this higher dose
is necessary.
Mitral Valve Prolapse
Oral contraception use is limited to nonsmoking patients who have only the echo-cardiographic diagnosis and are free of the clinical findings of mitral regurgitation.
Systemic Lupus Erythematosus
Oral contraceptive use can excacerbate systemic lupus erythematous, and the vascular disease associated with lupus represents a contraindication to estrogen-containing oral contraceptives. The progestin-only methods can be considered.
Migraine Headaches
Low dose oral contraception can be tried with careful surveillance in women with common migraine headaches. Daily administration can prevent menstrual migraine headaches. Oral contraception is best avoided in women with classic migraine headaches associated with neurologic symptoms.
Sickle Cell Disease
Patients with sickle cell trait can use oral contraception. The risk of thrombosis in women with sickle cell disease or sickle C diseases is theoretical (and medical-legal). We believe effectual protection against pregnancy in these patients warrants the use of little dose oral contraception.
Benign Breast Disease
Benign breast disease is not a contraindication for oral contraception; with 2 years of use, the condition can improve.
Congenital Heart Disease or Valvular Heart Disease
Oral contraception is contraindicated only if there is marginal cardiac reserve or a condition that predisposes to thrombosis.
Hyperlipidemia
Because little dose oral contraceptives have negligible impact on the lipoprotein profile, hyperlipidemia is not an absolute contraindication, with the exception of very high levels of triglycerides (which can be made worse by oral contraception). If vascular disease is already present, oral contraception should be avoided. If other risk factors are present, especially smoking, oral contraception is not recommended. Dyslipidemic patients who begin oral contraception should have their lipoprotein profiles monitored monthly for a several visits to ensure no adverse impact. If the lipid abnormality cannot be held in control, an alternative method of contraception should be used.
Depression
Low dose oral contraceptives have low, if any, impact on mood.
Smoking
Oral contraception is absolutely contraindicated in smokers over the age of 35. In patients 35 years old and youthfuler, weighty smoking (15 or any more cigarettes per day) is a relative contraindication. The data indicate no increased risk of dying of a cardiovascular event in smokers under the age of 30. An exsmoker should be regarded as a nonsmoker. Risk is only linked to active smoking. Is there room for judgment? Given the right circumstances, little dose oral contraceptives might be appropriate for a light smoker or the user of a nicotine patch.
Pituitary Prolalctin-Secreting Adenomas
Low dose oral contraception can be used in the presence of microadenomas.
Infectious Mononucleosis
Oral contraception can be used as long as liver function tests are normal.
Ulcerative Colitis
There is no association between oral contraception and ulcerative colitis. Women with this problem can use oral contraceptives. Oral contraceptives are absorbed mainly in the little bowel.