New Problems That May Require Switching Methods

May or may not be due to the method.

Unexplained vaginal bleeding (that suggests a medical condition not related to the method)

• Refer or evaluate by history and pelvic examination. Diagnose and treat as appropriate.
• She can continue using POPs while her condition is being evaluated.
• If bleeding is caused by a sexually transmitted infection or pelvic inflammatory disease, she can continue using POPs during treatment.

Starting treatment with anticonvulsants, rifampicin, or rifabutin

• Barbiturates, carbamazepine, oxcarbazepine, phenytoin, primidone, topiramate, rifampicin, rifabutin, and ritonavir may make POPs less effective. If using these medications long-term, she may want a different method, such as monthly injectables, progestin-only injectables, or a copper-bearing or LNG-IUD.
• If using these medications short-term, she can use a backup method along with POPs.

Migraine headaches (see Identifying Migraine Headaches and Auras)

• If she has migraine headaches without aura, she can continue to use POPs if she wishes.
• If she has migraine aura, stop POPs. Help her choose a method without hormones.

Certain serious health conditions (suspected blood clots in deep veins of legs or lungs, liver disease, or breast cancer). See Signs and Symptoms of Serious Health Conditions.

• Tell her to stop taking POPs.
• Give her a backup method to use until the condition is evaluated.
• Refer for diagnosis and care if not already under care.

Heart disease due to blocked or narrowed arteries (ischemic heart disease) or stroke

• A woman who has one of these conditions can safely start POPs. If, however, the condition develops after she starts using POPs, she should stop. Help her choose a method without hormones.
• Refer for diagnosis and care if not already under care.

Suspected pregnancy

• Assess for pregnancy, including ectopic pregnancy.
• Tell her to stop taking POPs if pregnancy is confirmed.
• There are no known risks to a fetus conceived while a woman is taking POPs (see Question 3).

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