The following exclusion criteria are developed in accordance with the USMEC guidelines. Our current recommendations exclude prescriptive authority for class III and IV conditions. Patients with these conditions should be referred to a physician. Uncontrolled hypertension is a class II indication for progesterone-only pills and injections, but our recommendation is these patients’ blood pressure should be stabilized before pharmacist intervention.

Table 2 – A Summary of Hormonal Contraceptive Classes by Condition

All Types of Hormonal Contraception:

• Pregnant or suspicion of pregnancy

Combined Oral Contraceptives (COCs):

• Blood pressure greater than 140/90 (Class III)

• Smoker and age > 35
• Breastfeeding
  • <21 days post-partum 
  • 30-42 days postpartum with Venous Thromboembolism (VTE) risk factors (30 to 42 days postpartum)
  • With other risk factors for VTE (e.g., age 35 years, previous VTE, thrombophilia, immobility, transfusion at delivery, peripartum cardiomyopathy, BMI above 30 kg/m2, postpartum hemorrhage, post-cesarean delivery, preeclampsia, or smoking)
• Not breastfeeding
  • <21 days post-partum
  • 21-42 days with VTE risk factors
• Superficial venous thrombosis
• Migraine with aura
• Multiple sclerosis with immobility
• Allergy to any components
• Malabsorption from bariatric surgery
• More than one risk factor for cardiovascular disease (high blood pressure, smoking, high cholesterol, diet, diabetes, inactivity, being overweight or obese, family history, age)
• Peripheral vascular disease
• Acute thrombosis or high risk of developing deep venous thrombosis (DVT) or pulmonary embolism (PE)
  • DVT/PE (History of estrogen-associated DVT/PE, Pregnancy-associated DVT/PE, recent major surgery with prolonged immobilization)
• Idiopathic DVT/PE, known as antiphospholipid syndrome
• Active cancer (metastatic, receiving therapy, or within six months after clinical remission), excluding nonmelanoma skin cancer 
• History of recurrent DVT/PE
• Known coagulation deficiencies
• History of stroke or CVD
• Complicated heart valve disease (pulmonary hypertension, risk for atrial fibrillation, history of endocarditis)
• Class III or IV heart failure
• Peripartum cardiomyopathy
• Antiphospholipid antibodies with systemic lupus erythematosus (SLE)
• Active or remote history of breast cancer
• Diabetes with nephropathy, retinopathy, neuropathy, or vascular disease
• Inflammatory bowel disease
• Gallbladder disease 
• Past cholestasis associated with COC use
• Acute viral hepatitis
• Decompensated cirrhosis
• Hepatocellular adenoma
• Malignant Hepatoma
• Complicated transplant graft failure
• Use of the medications fosamprenavir, efavirenz, phenytoin, carbamazepine, barbiturates, primidone, topiramate, oxcarbazepine, lamotrigine, rifampin, or rifabutin

Progestin Only Pill (POP):

• Malabsorptive disease with bariatric surgery
• Ischemic heart disease or stroke
• SLE with antiphospholipid antibodies
• Breast Cancer
• Decompensated cirrhosis
• Hepatocellular adenoma
• Malignant hepatoma
• Blood pressure greater than 140/90 (Class I or II)

Patch:

• BMI > 30

DMPA (Injection):

• Multiple CVD risk factors (high blood pressure, smoking, high cholesterol, diet, diabetes, inactivity, being overweight or obese, family history, age)
• Systolic blood pressure > 160 
• Diastolic blood pressure > 100
• Peripheral Vascular Disease
• Ischemic heart disease or stroke
• SLE with antiphospholipid antibodies
• SLE with severe thrombocytopenia
• Rheumatoid arthritis on immunosuppression (Class II/III)
• Unexplained vaginal bleeding
• Breast cancer
• Diabetes duration > 20 years
• Decompensated cirrhosis
• Hepatocellular adenoma
• Malignant hepatoma
• Blood pressure greater than 140/90 (Class I or II)