Table 6.1. WHO eligibility criteria for the use of hormonal contraceptives in women with cardiovascular diseases (CVDs).
| Condition | COC Patch Ring | Combined injectable | POP | Injectable DMPG | Transdermal | HIUD | |||
|---|---|---|---|---|---|---|---|---|---|
| Smoking | |||||||||
| <15 cigarettes/day | 3 | 2 | 1 | 1 | 1 | 1 | |||
| ≥15 cigarettes/day | 4 | 3 | 1 | 1 | 1 | ||||
| Multiple risk factors for CVD | |||||||||
| e.g. advanced age, smoking, diabetes, SAH, dyslipidemia | 3/4 | 3/4 | 2 | 3 | 2 | 2 | |||
| Hypertension | |||||||||
| History of SAH/BP cannot be assessed (includes gestational diabetes) | 3 | 3 | 2 | 2 | 2 | 2 | |||
| Controlled SAH, when BP can be measured | 3 | 3 | 1 | 2 | 1 | 1 | |||
| High SAH | |||||||||
| - SBP=140-159 or DBP=90-99 mm Hg | 3 | 3 | 1 | 2 | 1 | 1 | |||
| - SBP>160 or DBP>100 mm Hg | 4 | 4 | 2 | 3 | 2 | 2 | |||
| Vascular disease | 4 | 4 | 2 | 3 | 2 | 2 | |||
| DVT/PE | |||||||||
| History of DVT/PE | 4 | 4 | 2 | 2 | 2 | 2 | |||
| Acute VTE/PE | 4 | 4 | 3 | 3 | 3 | 3 | |||
| VTE/PE on anticoagulant therapy | 4 | 4 | 2 | 2 | 2 | 2 | |||
| Major surgery with long immobilization | 4 | 4 | 2 | 2 | 2 | 2 | |||
| Thrombogenic mutations | |||||||||
| Factor V Leiden, prothrombin, proteins C, S, or antithrombin | 4 | 4 | 2 | 2 | 2 | 2 | |||
| Ischemic heart disease | 4 | 4 | I | C | 3 | I | C | I | C |
| Current and history | 2 | 3 | 2 | 3 | 2 | 3 | |||
| Stroke | 4 | 4 | I | C | 3 | I | C | 2 | |
| Current and history | 2 | 3 | 2 | 3 | |||||
| Valvular heart disease | |||||||||
| Factors aggravating valvular diseases (pulmonary hypertension, risk of atrial fibrillation, history of infective endocarditis) | 4 | 4 | 1 | 1 | 1 | 2 | |||
BP: blood pressure; COC: combined oral contraceptive; CVD: cardiovascular disease; patch, transdermal patch; ring, vaginal ring; DBP: diastolic blood pressure; DPMG: depo-medroxyprogesterone; DVT: deep venous thrombosis; HIUD: hormonal intrauterine device with levonorgestrel; PE: pulmonary embolism; POP: progesterone oral pills; SAH: systemic arterial hypertension; SBP: systolic blood pressure; VTE: venous thromboembolism; C: continuous use; Category 1: Condition with no restriction on the use of the method; Category 2: Condition in which advantages exceed disadvantages in the use of the method; Category 3: Condition in which the risks exceed advantages in the use of the method; Category 4: Condition with unacceptable risk to health due to the use of the method.