The safe use of hormonal contraceptives requires a thorough personal and family history paying close attention to cardiovascular risk factors. High blood pressure or a history of high blood pressure can increase the risk of developing cardiovascular disease with hormonal contraceptive use.¹⁴ A pregnancy test is not required if a pharmacist is certain or reasonably certain the patient is not pregnant based upon the following criteria:¹⁵

• Absence of signs or symptoms of pregnancy

• The patient presents less than or equal to seven days after the start of menses

• The patient has not had sexual intercourse since the start of the last regular menstrual period

• The patient correctly and consistently uses a reliable method of contraception

• The patient is less than or equal to seven days after an abortion (spontaneous or induced)

• It is within four weeks of the patient giving birth

• If the patient is exclusively breastfeeding or has a ≥85% breastfeeding rate, is amenorrheic, and <6 months postpartum

A pregnancy test can be ordered at a practitioner’s discretion prior to initiating contraceptive therapy. In case of recent unprotected sexual intercourse within the last seven days, the pharmacist should consider offering emergency contraception if pregnancy is not desired before beginning hormonal contraception.

Table 1 – Recommended Contraceptive Screening By Type