PocketGuide: Medical Problems

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PocketGuide for Family Planning Service Providers

Medical Problems

Drug Interactions - Anticoagulants
Drug Interactions - Antiseizure Drugs
Ectopic Pregnancy
Familial Hyperlipidemia
Gall Bladder Problem
Headaches
Hepatitis
High Blood Pressure
HIV/AIDS
Ischemic Heart Disease/ Stroke

PROBLEM	Breast Lumps
METHODS WHICH SHOULD BE USED WITH CAUTION	COCs, CICs and POCs: Only clients with suspicious breast lumps (firm, nontender or fixed and which do not change during the menstrual cycle) need to be evaluated before using COCs, CICs or POCs.
APPROPRIATE CONTRACEPTIVE METHODS² (WHO Class 1, 2)	LAM COCs/CICs POCs IUDs Barriers Spermicides NFP Withdrawal Voluntary sterilization
COMMENTS	The vast majority of breast lumps in women of reproductive age are benign (not cancerous). For women with benign breast disease, use of hormonal methods (COCs, CICs and POCs) is appropriate.

PROBLEM	Cancer - Breast
METHODS WHICH SHOULD BE USED WITH CAUTION	COCs, CICs, Implants and PICs: Women with breast cancer should not use these methods. (WHO class 4) POPs: Women with breast cancer should avoid using POPs unless other more appropriate methods are not available or acceptable. (WHO class 3)
APPROPRIATE CONTRACEPTIVE METHODS² (WHO Class 1, 2)	LAM IUDs Barriers Spermicides NFP Withdrawal Voluntary sterilization
COMMENTS	Although there is no evidence that estrogens or progestins (COCs, CICs and POCs) cause breast cancer, it is a hormonally sensitive tumor. WHO recommends that women with a history of breast cancer but no evidence of current disease avoid using COCs, CICs and POCs unless other more appropriate methods are not available or acceptable. (WHO class 3)

PROBLEM	Cancer - Cervical
METHODS WHICH SHOULD BE USED WITH CAUTION	IUDs: Women awaiting or undergoing treatment should not use an IUD. (WHO class 4)
APPROPRIATE CONTRACEPTIVE METHODS² (WHO Class 1, 2)	LAM COCs/CICs POCs Barriers Spermicides NFP Withdrawal Voluntary sterilization
COMMENTS	In general, treatment of cervical cancer causes the woman to be sterile. IUDs may increase the risk of infection or excessive bleeding which may make the condition appear worse prior to treatment. There is little concern that COCs, CICs or POCs increase the risk of progression of carcinoma-in-situ (CIS) to invasive cancer.

PROBLEM	Cancer - Endometrial and Ovarian
METHODS WHICH SHOULD BE USED WITH CAUTION	IUDs: Women awaiting or undergoing treatment should not use an IUD. (WHO class 4)
APPROPRIATE CONTRACEPTIVE METHODS² (WHO Class 1, 2)	LAM COCs/CICs POCs Barriers Spermicides NFP Withdrawal Voluntary sterilization
COMMENTS	In general, treatment of endometrial and ovarian cancers causes the woman to be sterile. IUDs may increase the risk of infection or excessive bleeding which may make the condition appear worse prior to treatment. COC use reduces the risk of developing either endometrial or ovarian cancer while POC use reduces the risk of endometrial cancer.

PROBLEM	Cirrhosis
METHODS WHICH SHOULD BE USED WITH CAUTION	COCs: Women with severe cirrhosis should not use COCs. (WHO class 4) Women with mild cirrhosis should avoid using COCs unless other more appropriate methods are not available or acceptable. (WHO class 3) CICs and POCs: Women with severe cirrhosis should avoid using CICs or POCs unless other more appropriate methods are not available or acceptable. (WHO class 3) Women with mild cirrhosis generally may use CICs or POCs. (WHO class 2)
APPROPRIATE CONTRACEPTIVE METHODS² (WHO Class 1, 2)	LAM IUDs Barriers Spermicides NFP Withdrawal Voluntary sterilization
COMMENTS	COCs may be used by women who are asymptomatic (i.e., liver function has been normal for 3 months). Because COCs are metabolized by the liver, their use may alter the course of existing disease. The concern with CICs is less than that with COCs because the first-pass effect on the liver is eliminated. (The hormones in CICs initially pass directly from the injection site to the heart without first passing through the liver.)

PROBLEM	Congenital Uterine Anomalies (bicornate or double uterus or cervix)
METHODS WHICH SHOULD BE USED WITH CAUTION	IUDs: Women with any type of congenital uterine anomaly 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	Uterine anomalies distort the cavity and can cause difficulties in insertion, increase the risk of expulsion and decrease the effectiveness of an IUD.

PROBLEM	Depression (history, severe or recurrent)
METHODS WHICH SHOULD BE USED WITH CAUTION	COCs, CICs and POCs: Women with a history of depression, especially if severe or recurrent, should use these methods with caution.
APPROPRIATE CONTRACEPTIVE METHODS² (WHO Class 1, 2)	LAM IUDs Barriers Spermicides NFP Withdrawal Voluntary sterilization
COMMENTS	Depression may be related to the progestin in COCs, CICs and POCs. If a women thinks depression has worsened while using COCs, CICs or POCs, help her choose another method. For women with a history of severe or recurrent episodes of depression, a trial of POPs may be preferable before giving implants or PICs because these methods cannot be stopped easily.

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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