When to Avoid Certain Types of Contraception

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When to Avoid Certain Types of Contraception
Contraception has come a long ways in the last 50 years, sparking the sexual revolution of the 1960's and giving women and couples a great variety of options for planning and timing their reproduction. Still there are some types of contraception that are best avoided for people with certain types of medical conditions and specific needs. One key consideration is whether you want temporary or permanent. Contraception has come a long ways in the last 50 years, sparking the sexual revolution of the 1960\'s and giving women and couples a great variety of options for planning and timing their reproduction. Still there are some types of contraception that are best avoided for people with certain types of medical conditions and specific needs. One key consideration is whether you want temporary or permanent.

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Contraception has come a long ways in the last 50 years, sparking the sexual revolution of the 1960's and giving women and couples a great variety of options for planning and timing their reproduction. Still there are some types of contraception that are best avoided for people with certain types of medical conditions and specific needs.

One key consideration is whether you want temporary or permanent. One of the most common mistakes that I see is men who choose to have a vasectomy and then have a change of mind or change of circumstances and decide they later want to father a child. Vasectomy reversal is always expensive and frequently ineffective, so men and women should be certain of their desire for permanent contraception before choosing tubal ligation or vasectomy.

For temporary contraception there are specific reasons to avoid various types of birth control, and here are a few of the more important ones:

  • Breast Cancer: women with breast cancer need to avoid all types of hormonal contraception.
  • Diabetes of over 20 years duration or with major complications: these patients should generally not take combined estrogen-progestin contraceptives (combination OCPs).
  • Migraine headache with aura: avoid combination OCPs to avoid risk of vascular accidents.
  • Migraine without aura in women over age 35: should avoid initiation of combination OCPs.
  • Smoking >3/4 pack/day and age > 35: puts at risk of stroke and DVT with combination OCPs.
  • BP > 160/100: stay away from combination pills
  • Stroke history: strong reason not to use combination pills
  • Hepatocellular adenoma or carcinoma: avoid combination OCPs
  • Major surgery that requires prolonged bed rest or immobilization: avoid combination OCPs to reduce risk of blood clots in the legs.
  • Prior DVT: avoid combination pills
  • Significant distortion of the uterine cavity from congenital abnormality or fibroids: avoid IUD
  • Significant pelvic infections: No new IUD placement, some require IUD removal.

A more comprehensive review is available in American Family Physician.