History
Prior to prescribing a hormonal contraceptive, a thorough history
should be taken, including present and past medical history (eg cardiovascular
[CV] risk factors, allergies, migraine, presence of comorbidities), personal
history (eg smoking history, sexual history), current medications, and
potential contraindications (please see subsequent discussion on each hormonal
contraceptive for details).
Women with the following medical
conditions, for whom unintended pregnancy poses high health risks, should avoid
relying solely on barrier or behavior-based contraception methods:
- Breast cancer
- Complicated valvular heart disease
- Diabetes (insulin-dependent or with nephropathy/retinopathy/neuropathy or other vascular disease, or of >20 years’ duration)
- Endometrial or ovarian cancer
- Epilepsy
- Systolic blood pressure (SBP) >160 mmHg or diastolic BP (DBP) >100 mmHg
- HIV (WHO stages 1-4)
- Ischemic heart disease
- Malignant gestational trophoblastic disease
- Malignant liver tumors (hepatoma) and hepatocellular carcinoma
- Schistosomiasis with liver fibrosis
- Severe (decompensated) cirrhosis
- Sickle cell disease
- STI
- Stroke
- Systemic lupus erythematosus (SLE)
- Thrombogenic mutations
- Tuberculosis (TB)
Physical Examination
Physical examination should include assessing BP and body weight, breast exam, abdominal exam, and pelvic/genital exam. Pelvic/genital exam is preferably done with cervical cytologic screening. This is an important aspect of preventive medicine but is not mandatory and may be postponed until the follow-up visit.