Using Clinical Judgment in Special Cases

Usually, a woman with any of the conditions listed below should not use POPs. In special circumstances, however, when other, more appropriate methods are not available or acceptable to her, a qualified provider who can carefully assess a specific woman’s condition and situation may decide that she can use POPs. The provider needs to consider the severity of her condition and, for most conditions, whether she will have access to follow-up.

• Breastfeeding and less than 6 weeks since giving birth
• Acute blood clot in deep veins of legs or lungs
• Had breast cancer more than 5 years ago, and it has not returned
• Severe liver disease, infection, or tumor
• Systemic lupus erythematosis with positive (or unknown) antiphospholipid antibodies
• Taking barbiturates, carbamazepine, oxcarbazepine, phenytoin, primidone, topiramate, rifampicin, rifabutin or ritonavir or ritonavir-boosted protease inihbitors. A backup contraceptive method should also be used because these medications reduce the effectiveness of POPs.