Chronic Diseases and Contraceptive Use

•  Copper IUD is a good contraceptive choice.
• According to the World Health Organization (WHO), combined oral contraceptives (OCs), combined injectables, DMPA, NET-EN and Norplant are contraindicated. Progestin-only pills and LNg-IUDs are usually undesirable to initiate.

• In general, treatment of these cancers causes sterility.
• If treatment is not available and contraception is needed, OCs, progestin-only pills, combined injectables, DMPA, NET-EN and Norplant are good choices.
• Use of Copper or LNg-IUDs should not be initiated, but may be continued if the cancer develops during use. 

• Progestin-only pills, DMPA, NET-EN, Norplant and both Copper and LNg-IUDs are good choices.
• Sterilization should be delayed until the condition is treated and resolved.
• OCs or combined injectables are contraindicated.

Past (excluding hypertension in pregnancy) or mild (140-159/90-99 mm Hg)

• Progestin-only pills, Norplant and both Copper and LNg-IUDs are good choices.
• OCs and combined injectables are usually undesirable methods or are second choices (methods for which health benefits outweigh potential risks). DMPA and NET-EN are second choices.
• For female sterilization, hypertension increases general anesthesia risks. Hypertension does not affect the safety of vasectomy.

Moderate (160-179/100-109 mm Hg)

• Progestin-only pills, Norplant and both Copper and LNg-IUDs are good choices. DMPA and NET-EN are second choices.
• Combined injectables are usually undesirable. OCs are generally contraindicated. If moderate hypertension develops during use, OCs should be discontinued.
• For female sterilization, hypertension increases general anesthesia risks.

Severe (180/110 mm Hg or greater) or vascular disease

• Copper IUD is a good choice. Progestin-only pills, Norplant and LNg-IUDs are second choices. DMPA and NET-EN are usually undesirable methods.
• OCs and combined injectables are contraindicated.
• For female sterilization, hypertension increases general anesthesia risks.

Without vascular disease

• All methods can be used.
• Female and male sterilization can be performed but with extra precautions to anticipate possible hypoglycemia or ketoacidosis, and the increased risk of postoperative wound infections.

With vascular disease or diabetes for more than 20 years

• The Copper IUD is a good contraceptive choice. Progestin-only pills, Norplant and LNg-IUDs are second choices.
• OCs and combined injectables either are contraindicated or are usually undesirable methods of choice.
• DMPA and NET-EN are usually undesirable choices.
• For female sterilization, refer client to a center with additional medical support for potential complications. Male sterilization can be performed but with extra preparation and precaution since diabetes increases the risk of postoperative infection.

• The Copper IUD is a good choice for women with active viral hepatitis, cirrhosis or liver tumors.
• Progestin-only pills, DMPA, NET-EN, Norplant and the LNg-IUD are methods of last choice for women with active viral hepatitis, severe cirrhosis or liver tumors.
• OCs are contraindicated in women with active viral hepatitis, severe cirrhosis, or any kind of liver tumor, and are a last choice for women with mild cirrhosis.

• DMPA and the Copper or LNg-IUDs are good contraceptive choices.
• For women taking anticonvulsants (except valproic acid), the efficacy of OCs, progestin-only pills, combined injectables and Norplant may be reduced.
• Female sterilization can be performed with extra precautions.

• Copper and LNg-IUDs, and sterilization are good choices.
• OCs and combined injectables are not recommended.
• Progestin-only pills, DMPA, NET-EN or Norplant are usually undesirable methods if this type of headache develops during their use.

• Progestin-only methods (pills, injectables, Norplant or LNg-IUD) are good choices.
• WHO recommends combined hormonal methods (pills and injectables) and Copper IUD as second choices (methods for which health benefits outweigh potential risks).

Sources:
World Health Organization. Improving Access to Quality Care in Family Planning. Medical Eligibility Criteria for Contraceptive Use. Geneva: World Health Organization,1996; U.S. Agency for International Development. Recommendations for Updating Selected Practices in Contraceptive Use: Volumes I/II. Washington: U.S. Agency for International Development, 1994/1997.