Who Can and Cannot Use Combined Oral Contraceptives

Safe and Suitable for Nearly All Women

Nearly all women can use COCs safely and effectively, including women who:

Have or have not had children
Are married or are not married
Are of any age, including adolescents and women over 40 years old
After childbirth and during breastfeeding, after a period of time
Have just had an abortion, miscarriage, or ectopic pregnancy
Smoke cigarettes—if under 35 years old
Have anemia now or had in the past
Have varicose veins
Are living with HIV, whether or not on antiretroviral therapy

Avoid Unnecessary Procedures

(see Importance of Selected Procedures in Chapter 26 – Family Planning Provision)

Women can begin using COCs:

Without a pelvic examination
Without any blood tests or other routine laboratory tests
Without cervical cancer screening
Without a breast examination
Without a pregnancy test. A woman can begin using COCs at any time, even when she is not having monthly bleeding at the time, if it is reasonably certain she is not pregnant (see Pregnancy Checklist).

Blood pressure measurement is desirable before starting a hormonal method. However, where the risks of pregnancy are high and few methods are available, a woman should not be denied a hormonal method simply because her blood pressure cannot be measured. If possible, she can have her blood pressure measured later at a time and place convenient for her.