Hormone Contraceptives in Special Populations

Question 5

Bariatric Surgery Patients

-Pertains only to those who’ve had malabsorptive surgery (bilopancreatic diversion and Roux-en-Y), NOT restrictive surgery

Answer 5

• Avoid oral contraceptives

- Recommend vaginal ring, patch or injection

Question 6

Breast Cancer Patients

Answer 6

Current or history of breast cancer should not use hormone contraceptives

No restrictions for benign or family hx of breast disease

Question 7

Diseases Treated with Antiepileptics or Antiretroviral

Answer 7

-Avoid hormone contraceptives in those taking phenyoin, carbamazepine, barbiturates, primidone, topiramate, oxcarbazepine

-Those on lamotrigine = can take POPS
(Estrogen decreases lamotrigine levels by 50%)

-Those on protease inhibitor fosamprenavir can take POPs and injections

Question 8

Depression Patients

Answer 8

• Avoid progestins as it may exacerbate depression (esp the inj progestin cause it is long acting)
• Most other hormone contraceptives may be used

Question 9

Diabetic Patients

Hormone contraceptives may impair glucose and carbohydrate metabolism

Answer 9

• Avoid combination hormone contraceptives for those with diabetes + nephropathy, retinopathy, neuropathy, or vascular
• Avoid combination hormone contraceptives for those with diabetes for over 20 years
• Recommend Progestin only products for these patients

Question 10

History of VTE

Answer 10

-Avoid combined hormone contraceptives

Question 11

Hepatic Dysfunction Patients

Answer 11

-Acute hepatitis, liver cancer, cirrhosis, hx of gallbladder disease, cholestasis = Avoid combined hormone contraceptives

Question 12

Migraine Patients

Answer 12

• Migraines with Aura = Avoid combined hormone contraceptives; use Progestin only products
• Migraines without aura = can use CHC or Progestin only products

Question 13

Lupus Patients with positive or unknown antiphospholiid antibody test

Answer 13

-Avoid hormone contraceptives altogether because antiphospholipid antibodies can increase risk of ischemic heart disease, stroke, VTe

Question 14

Rheumatoid Arthritis Patients

Answer 14

• Avoid injections because of risks of fractures

- Consider oral hormone contraceptives OR Progestin only products for RA pts also on steroids

Question 15

Postpartum and Breastfeeding Patients

Hypercoagulable for 21 days after childbirth is

Answer 15

-Avoid combined hormone contraceptives within 21 days postpartum, but can use Progestin only products or injection

After 21 Days postpartum…
-Breastfeeding = Progestin only products preferred.
(21-30 days) = those at high risk for BRE should avoid CHCs, otherwise all other hormone contraceptives may be used
(After 42 days) = all hormone contraceptives can be used

-Non-Breastfeeding = (21-42 days) postpartum CHCs are not recommended in those with risk factors for VTE, otherwise if no high risk factors then can use any hormone contraceptives

Question 16

Ischemic Heart Disease & Stroke

Answer 16

• Those with current or history of IHD or stroke should not use combined hormone contraceptives or injection
• May consider progestin only products but D/C if ischemic symptoms worsen

Question 17

HTN and HLD Patients

Answer 17

• HTN = Avoid combined hormone contraceptives; use progestin only products or injection
• HLD = can use combined hormone contraceptives if no risk for other cardiovascular factors or severe genetic lipid disorders that increases risk of cardiovascular disease

Question 18

Characteristics that Increase the Risk of VTE with CHCs

Answer 18

Smoking, Age 35+, Obesity (BMI >30), Recent major surgery

1. Smoking + age <35 yrs = May use CHCs, POPs or inj. (max dose of ethinyl estradiol <50mcg)
2. Smoking + age > 35 yrs = Avoid CHCs. May use POPs or inj
3. Obesity = May use CHCs, POPs or inj. (max dose of ethinyl estradiol <50mcg). Avoid CHC patch in women >198 lbs
4. Recent surgery w/ prolonged immobility = Avoid CHCs. May use POPs or inj.