Primary care physicians often prescribe
contraceptives to women of reproductive age with comorbidities. Novel delivery systems (e.g.,
contraceptive patch,
contraceptive ring, single-rod implantable device) may change traditional risk and benefit profiles in women with comorbidities. Effective
contraceptive counseling requires an understanding of a woman's preferences and medical history, as well as the risks, benefits, adverse effects, and
contraindications of each method. Noncontraceptive benefits of combined hormonal
contraceptives, such as
oral contraceptive pills, include regulated menses, decreased
dysmenorrhea, and diminished
premenstrual dysphoric disorder.
Oral contraceptive pills may be used safely in women with a range of medical conditions, including well-controlled
hypertension, uncomplicated
diabetes mellitus, depression, and uncomplicated
valvular heart disease. However, women older than 35 years who
smoke should avoid
oral contraceptive pills.
Contraceptives containing
estrogen, which can increase thrombotic risk, should be avoided in women with a history of
venous thromboembolism,
stroke, cardiovascular disease, or
peripheral vascular disease.
Progestin-only
contraceptives are recommended for women with
contraindications to
estrogen.
Depo-Provera, a long-acting
injectable contraceptive, may be preferred in women with
sickle cell disease because it reduces the frequency of painful crises. Because of the interaction between
antiepileptics and
oral contraceptive pills,
Depo-Provera may also be considered in women with
epilepsy.
Implanon, the single-rod implantable
contraceptive device, may reduce symptoms of
dysmenorrhea.
Mirena, the
levonorgestrel-containing intrauterine
contraceptive system, is an option for women with
menorrhagia,
endometriosis, or chronic
pelvic pain.