What are the risks?
1. Blood clots
- A personal history of VTE (blood clots) or a known thrombogenic mutation (genetic problems that increase your risk of forming blood clots) are conditions that represent an unacceptable health risk if CHC is used.
- For women with a family history of VTE, a negative thrombophilia screen does not necessarily exclude all thrombogenic mutations and a thrombophilia screen is not recommended routinely before prescribing CHC.
- The UKMEC classifies having a first-degree relative with a history of VTE under the age of 45 years as a UKMEC 3(risk outweights benefits).
- Use of CHC in women aged ≥35 years who smoke is not recommended.
3. Risk of ischaemic stroke
- Health professionals should be aware that there may be a very small increase in the absolute risk of ischaemic stroke associated with CHC use.
4. Blood pressure
- Systolic BP ≥160 mmHg or diastolic BP ≥95 mmHg is a condition that represents an unacceptable health risk if CHC is used.
- The risk of using CHC in women with a BMI ≥35kg/m2 usually outweighs the benefits.
- CHC should not be used in women with migraine with aura.
- Any risk of breast cancer associated with CHC use is likely to be small, and will reduce with time after stopping.
- A family history of breast cancer therefore does not restrict use of CHC (UKMEC 1).
What are the benefits of using Combined Hormonal Contraceptives?
- Reduced risk of ovarian and endometrial cancer that continues for several decades after stopping.
- May help to improve acne.
- COC use is associated with a reduction in the risk of colorectal cancer and this may also apply to other CHCs.
- May help to reduce menstrual pain and bleeding.
- May reduce menopausal symptoms.
- Current evidence does not support a causal association between CHC and weight gain.