Using Clinical Judgment in Special Cases

Usually, a woman with any of the conditions listed below should not use progestin-only injectables. 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 progestin-only injectables. 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 (considering the risks of another pregnancy and that a woman may have limited further access to injectables)
• Severe high blood pressure (systolic 160 mm Hg or higher or diastolic 100 mm Hg or higher)
• Acute blood clot in deep veins of legs or lungs
• History of heart disease or current heart disease due to blocked or narrowed arteries (ischemic heart disease)
• History of stroke
• Multiple risk factors for arterial cardiovascular disease such as diabetes and high blood pressure
• Unexplained vaginal bleeding before evaluation for possible serious underlying condition
• Had breast cancer more than 5 years ago, and it has not returned
• Diabetes for more than 20 years or damage to arteries, vision, kidneys, or nervous system caused by diabetes
• Severe liver disease, infection, or tumor
• Systemic lupus erythematosus with positive (or unknown) antiphospholipid antibodies or, if starting a progestin-only injectable, severe thrombocytopenia