General contraindications to combined oral hormonal contraceptive

These include:

• Consent not given.
• Individuals under 16 years of age and assessed as not competent using Fraser Guidelines.
• Individuals 16 years of age and over and assessed as lacking capacity to consent.
• Known or suspected pregnancy.
• Known hypersensitivity to the active ingredient or to any constituent of the product - see Summary of Product Characteristics
• Less 21 days after childbirth (for deliveries over 24 weeks gestation)
• Breastfeeding and less than six weeks postpartum.
• Not breastfeeding and 3-6 weeks post-partum with other risk factors for venous thromboembolism (VTE).
• Individuals aged 50 years and over.

Cardiovascular disease

• Individuals aged 35 years or more and smoking or stopped smoking less than one year ago
• Body Mass Index (BMI) equal to or greater than 35kg/m2
• Blood pressure greater than 140/90mmHg or controlled hypertension
• Multiple risk factors for cardiovascular disease (CVD) (such as smoking, diabetes, hypertension, obesity and dyslipidaemias)
• Current or past history of ischaemic heart disease, vascular disease, stroke or transient ischaemic attack
• Current or past history of venous thromboembolism
• Complicated valvular or congenital heart disease e.g. pulmonary hypertension, history of subacute bacterial endocarditis
• First degree relative with venous thromboembolism under 45 years of age
• Known thrombogenic mutations e.g. factor V Leiden, prothrombin mutation, protein S, protein C and antithrombin deficiencies
• Cardiomyopathy with impaired cardiac function
• Atrial fibrillation
• Significant or prolonged immobility.
• Imminent planned major surgery (COC should be stopped at least 4 weeks prior to planned major surgery or expected period of limited mobility).

Neurological Conditions

• Current or past history of migraine with neurological symptoms including aura at any age
• Migraine without aura, first attack when on method of contraception containing an estrogen

Cancers

• Past or current history of breast cancer
• Undiagnosed breast mass (for initiation of method only)
• Carrier of known gene mutations associated with breast cancer e.g. BRCA1or 2
• Malignant liver tumour (hepatocellular carcinoma)

Gastro-intestinal Conditions

• Viral hepatitis, acute or flare (for initiation only)
• Severe decompensated cirrhosis
• Gall bladder disease, symptomatic, medically treated
• Gall bladder disease, currently symptomatic
• Any bariatric or other surgery resulting in malabsorption.
• Cholestasis (related to past combined hormonal contraceptive use)
• Benign liver tumour (hepatocellular adenoma)

Other conditions

• Diabetes with end organ disease (retinopathy, nephropathy, neuropathy)
• Positive anti-phospholipid antibodies (with or without systemic lupus erythematosus)
• Organ transplant, with complications
• Individuals using enzyme-inducing drugs/herbal products or within 4 weeks of stopping them.
• Known severe renal impairment or acute renal failure
• Acute porphyria

Interacting medicines (other than enzyme inducers) – see current British National Formulary (BNF) www.bnf.orgor individual product SPC http://www.medicines.org.uk

• breastfeeding - UKMEC score varies with respect to timing of use of combined hormonal contraception (2)

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Reference:

• Patient Group Direction (PGD) (NHS Specialist Pharmacy Service). Supply of a combined oral hormonal contraceptive (COC) . (Accessed 17th March 2021).
• FSRH Guideline (January 2019; amended November 2020). Combined Hormonal Contraception