CARDIOVASCULAR DISEASE

_

  = Use the method

_

  = Do not use the method

I

  = Initiation of the method

C

  = Continuation of the method

  = Use the method

NA

  = Not applicable

Condition

Combined oral contraceptives Monthly injectables Combined patch and combined vaginal ring Progestin-only pills Progestin-only injectables Implants Emergency contraceptive pills* Copper-bearing intrauterine device Levonorgestrel intrauterine device Female sterilization*
CARDIOVASCULAR DISEASE
Multiple risk factors for arterial cardiovascular disease (older age, smoking, diabetes, and hypertension) 3/4d 3/4d 3/4d 2 3 2 1 2 S
Hypertensione  
History of hypertension, where blood pressure CANNOT be evaluated (including hypertension in pregnancy) 3 3 3 2c 2c 2c 1 2 NA
Adequately controlled hypertension, where blood pressure CAN be evaluated 3 3 3 1 2 1 1 1 C
Elevated blood pressure (properly measured)  
Systolic 140–159 or

diastolic 90–99
3 3 3 1 2 1 1 1 Cf
Systolic ≥ 160 or

diastolic ≥ 100g
4 4 4 2 3 2 1 2 Sf
Vascular disease 4 4 4 2 3 2 1 2 S
History of high blood pressure during pregnancy (where current blood pressure is measurable and normal) 2 2 2 1 1 1 1 1 A
Deep venous thrombosis (DVT)/Pulmonary embolism (PE)  
History of DVT/PE 4 4 4 2 2 2 * 1 2 A
Acute DVT/PE 4 4 4 3 3 3 * 1 3 D
DVT/PE and on anticoagulant therapy 4 4 4 2 2 2 * 1 2 S
Family history of DVT/PE (first-degree relatives) 2 2 2 1 1 1 * 1 1 A
Major surgery  
With prolonged immobilization 4 4 4 2 2 2 1 2 D
Without prolonged immobilization 2 2 2 1 1 1 1 1 A
Minor surgery without prolonged immobilization 1 1 1 1 1 1 1 1 A
Known thrombogenic mutations (e.g., Factor V Leiden, Prothrombin mutation; Protein S, Protein C, and Antithrombin deficiencies)g 4 4 4 2 2 2 * 1 2 A
Superficial venous thrombosis  
Varicose veins 1 1 1 1 1 1 1 1 A
Superficial thrombophlebitis 2 2 2 1 1 1 1 1 A
Ischemic heart diseaseg    I C    I C    I C  
Current 4 4 4 2 3 3 2 3 * 1 2 3 D
History of C
Stroke (history of cerebrovascular accident)g 4 4 4 2 3 3 2 3 * 1 2 C
Known hyperlipidemias 2/3h 2/3h 2/3h 2 2 2 1 2 A
Valvular heart disease  
Uncomplicated 2 2 2 1 1 1 1 1 Ci
Complicated g 4 4 4 1 1 1 2i 2i S*

d When multiple major risk factors exist, any of which alone would substantially increase the risk of cardiovascular disease, use of the method may increase her risk to an unacceptable level. However, a simple addition of categories for multiple risk factors is not intended. For example, a combination of factors assigned a category 2 may not necessarily warrant a higher category.

e Assuming no other risk factors for cardiovascular disease exist. A single reading of blood pressure is not sufficient to classify a woman as hypertensive.

f Elevated blood pressure should be controlled before the procedure and monitored during the procedure.

g This condition may make pregnancy an unacceptable health risk. Women should be advised that because of relatively higher pregnancy rates, as commonly used, spermicides, withdrawal, fertility awareness methods, cervical caps, diaphragms, or female or male condoms may not be the most appropriate choice.

h Assess according to the type and severity of hyperlipidemia and the presence of other cardiovascular risk factors.

Pulmonary hypertension, atrial fibrillation, history of subacute bacterial endocarditis

i Prophylactic antibiotics are advised before providing the method.

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