Ask the client the questions below about known medical conditions. Examinations and tests are not necessary. If she answers “no” to all of the questions, then she can start POPs if she wants. If she answers “yes” to a question, follow the instructions. In some cases she can still start POPs.

1.   Do you have severe cirrhosis of the liver, or severe tumor?

NO   YES If she reports severe cirrhosis or severe liver tumor (such as liver cancer), do not provide POPs. Help her choose a method without hormones.

2.   Do you have a serious problem now with a blood clot in your leg or lungs?

NO   YES If she reports a current blood clot in a leg (affecting deep veins, not superficial veins) or in a lung, and she is not on anticoagulant therapy, do not provide POPs. Help her choose a method without hormones.

4.   Are you taking medication for seizures? Are you taking rifampicin or rifabutin for tuberculosis or other illness?

NO   YES If she is taking barbiturates, carbamazepine, oxcarbazepine, phenytoin, primidone, topiramate, rifampicin, or rifabutin, do not provide POPs. They can make POPs less effective. Help her choose another method but not combined oral contraceptives.

5.   Do you have or have you ever had breast cancer?

NO   YES Do not provide POPs. Help her choose a method without hormones.

Also, women should not use POPs if they report having thrombogenic mutations or lupus with positive (or unknown) antiphospholipid antibodies. For complete classifications, see Appendix D - Medical Eligibility Criteria for Contraceptive Use.

Be sure to explain the health benefits and risks and the side effects of the method that the client will use. Also, point out any conditions that would make the method inadvisable, when relevant to the client.