|
| PROBLEM |
Seizure Disorders (Epilepsy) |
| METHODS WHICH SHOULD BE USED WITH CAUTION |
COCs, CICs, Implants and POPs:
Women using antiseizure drugs should avoid using these methods unless other more
appropriate methods are not available or acceptable. (WHO
class 3) |
APPROPRIATE CONTRACEPTIVE METHODS2
(WHO Class 1, 2)
|
- LAM
- PICs
- IUDs
- Barriers
- Spermicides
- NFP
- Withdrawal
- Voluntary sterilization
|
| COMMENTS |
COCs do not affect either the frequency
or severity of seizures. POPs and PICs may reduce seizure occurrence. Long-term
use of antiseizure drugs causes the liver to metabolize estrogens and progestins more
rapidly and may decrease the effectiveness of all hormonal methods except PICs. The
effectiveness of PICs is not decreased because blood levels of the
progestins are sufficient to compensate for the increased metabolism.
Development of intermenstrual bleeding or spotting may
indicate a decreased level of sex steroid hormones (estrogen and progestin) due to
interactions with antiseizure drugs. If this occurs in a client using a COC containing
30–35µg EE, consider using a COC with a higher estrogen level (50 µg EE) or help
her choose another method. If using a CIC or POP, help client choose another method. |
|
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|
| PROBLEM |
Sickle Cell
Disease and Trait |
| METHODS WHICH SHOULD BE USED WITH CAUTION |
|
APPROPRIATE CONTRACEPTIVE METHODS2
(WHO Class 1, 2)
|
- LAM
- COCs/CICs
- POCs
- IUDs
- Barriers
- Spermicides
- NFP
- Withdrawal
- Voluntary sterilization
|
| COMMENTS |
All contraceptive methods can be
used. POCs are recommended. Implants and PICs are preferred over POPs, especially if
the woman frequently is ill and not eating or drinking regularly. (Use of PICs and
possibly implants may decrease the frequency of attacks.)
For women with sickle cell disease, prevention
of unwanted pregnancy is very important for health reasons. |
|
|
| PROBLEM |
Smoker and age
35 years or older |
| METHODS WHICH SHOULD BE USED WITH CAUTION |
COCs: Client should not use COCs.
(WHO class 4) CICs: Client should avoid using
CICs unless other more appropriate methods are not available or acceptable. (WHO class 3) |
APPROPRIATE CONTRACEPTIVE METHODS2
(WHO Class 1, 2)
|
- LAM
- POCs
- IUDs
- Barriers
- Spermicides
- NFP
- Withdrawal
- Voluntary sterilization
|
| COMMENTS |
Women 35 years or older who smoke (heavy
or light4) already are at increased risk of heart attack, stroke
and other blood clotting problems. Use of COCs or CICs by these women poses an additional
risk of blood clotting problems (estrogen effect). Help client choose another
(nonestrogen) method. Women 35 years or older who stop smoking and have no other risk
factors may use COCs or CICs. |
|
|
| PROBLEM |
Symptomatic
valvular heart disease (rheumatic or congenital) |
| METHODS WHICH SHOULD BE USED WITH CAUTION |
COCs and CICs: Women with
symptomatic valvular heart disease should not use COCs or CICs. (WHO class 4) IUDs: Prior to inserting an IUD,
prophylactic antibiotics are advised if the woman is not already receiving
long-acting antibiotics. |
APPROPRIATE CONTRACEPTIVE METHODS2
(WHO Class 1, 2)
|
- LAM
- POCs
- IUDs
- Barriers
- Spermicides
- NFP
- Withdrawal
- Voluntary sterilization
|
| COMMENTS |
Use of COCs or CICs with symptomatic
valvular heart disease poses an additional risk for blood clotting problems (estrogen
effect). The use of prophylactic antibiotics reduces the risk of infection and possible
subacute bacterial endocarditis during IUD insertion.
Clients with Class III–IV heart disease should
consider voluntary sterilization. Even if one pregnancy has been successful,
further pregnancies are extremely risky. |
|
|
| PROBLEM |
Thromboembolic
disorders (e.g., blood clots in legs, lungs or eyes) |
| METHODS WHICH SHOULD BE USED WITH CAUTION |
COCs and CICs: Women with
blood clotting disorders (current or history of) should not use COCs or CICs. (WHO class 4) |
APPROPRIATE CONTRACEPTIVE METHODS2
(WHO Class 1, 2)
|
- LAM
- POCs
- IUDs
- Barriers
- Spermicides
- NFP
- Withdrawal
- Voluntary sterilization
|
| COMMENTS |
While COCs and CICs only slightly
increase the risk of venous blood clotting problems in healthy women, this increased risk
may have substantial impact on women already at risk for venous thromboembolism (e.g.,
women with current or past blood clots or recovering from major surgery with prolonged bed
rest). POCs do not increase a woman's risk for venous blood clotting problems. |
|
|
| PROBLEM |
Tuberculosis |
| METHODS WHICH SHOULD BE USED WITH CAUTION |
COCs, CICs, Implants and POPs:
Women using rifampin for tuberculosis should avoid using these methods unless other more
appropriate methods are not available or acceptable. (WHO
class 3) IUDs: Women with known pelvic
TB should not use an IUD. (WHO class 4) |
APPROPRIATE CONTRACEPTIVE METHODS2
(WHO Class 1, 2)
|
- LAM
- PICs
- Barriers
- Spermicides
- NFP
- Withdrawal
- Voluntary sterilization
|
| COMMENTS |
Long-term use of rifampin for
tuberculosis causes the liver to metabolize estrogens and progestins more rapidly and may
decrease the effectiveness of all hormonal methods except PICs. Development of
intermenstrual spotting or bleeding may indicate a decreased level of sex steroid hormones
(estrogen and progestin) due to interactions with rifampin. If this occurs, consider using
a COC with a higher estrogen level (50 µg EE) or help client choose another method (COC,
CIC, implants or POP).
The effectiveness of PICs is not
decreased because blood levels of the progestins are sufficient to compensate for the
increased metabolism.
Use of an IUD may increase risk of secondary infection
and uterine bleeding. |
|
|
| PROBLEM |
Uterine Fibroids |
| METHODS WHICH SHOULD BE USED WITH CAUTION |
IUDs: Women with uterine fibroids
or scar tissue in the endometrium (uterine synechiae) that distort the uterine cavity
should not use IUDs. (WHO class 4) |
APPROPRIATE CONTRACEPTIVE METHODS2
(WHO Class 1, 2)
|
- LAM
- COCs/CICs
- POCs
- Barriers
- Spermicides
- NFP
- Withdrawal
- Voluntary sterilization
|
| COMMENTS |
Large fibroids, especially if they are
submucous, and uterine synechiae distort the uterine cavity and can cause difficulties in
insertion, increase the risk of IUD expulsion and decrease effectiveness. Although
estrogens can stimulate growth of uterine fibroids, low-dose COCs (30–35µg EE) do
not appear to cause them to grow. |
|
|
1 For women with life-threatening medical problems
who are in mutually faithful relationships, vasectomy often is the safest long-term method
for the couple.
2 Most appropriate methods are boldfaced.
3 Because griseofulvin usually is used only for a short
period of time (2 to 4 weeks), women taking it for fungal infections can continue to use
these methods. They should use a backup method while taking griseofulvin and until the
start of the next menstrual period after stopping the antibiotic.
4 Definitions of heavy smoking vary internationally.
Throughout this PocketGuide the WHO definition, 20 cigarettes or more per day, is used.
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