general contraindications to combined oral hormonal contraceptive

Last edited 03/2021 and last reviewed 03/2021

These include:

  • Consent not given. 
  • Individuals under 16 years of age and assessed as not competent using Fraser Guidelines.
  • Individuals 16 years of age and over and assessed as lacking capacity to consent.
  • Known or suspected pregnancy.
  • Known hypersensitivity to the active ingredient or to any constituent of the product - see Summary of Product Characteristics
  • Less 21 days after childbirth (for deliveries over 24 weeks gestation)
  • Breastfeeding and less than six weeks postpartum. 
  • Not breastfeeding and 3-6 weeks post-partum with other risk factors for venous thromboembolism (VTE).
  • Individuals aged 50 years and over.

Cardiovascular disease

  • Individuals aged 35 years or more and  smoking or stopped smoking less than one year ago
  • Body Mass Index (BMI) equal to or greater than 35kg/m2
  • Blood pressure greater than 140/90mmHg or controlled hypertension                                                                                   
  • Multiple risk factors for cardiovascular disease (CVD) (such as smoking, diabetes, hypertension, obesity and dyslipidaemias)
  • Current or past history of ischaemic heart disease, vascular disease, stroke or transient ischaemic attack
  • Current or past history of venous thromboembolism
  • Complicated valvular or congenital heart disease e.g. pulmonary hypertension, history of subacute bacterial endocarditis
  • First degree relative with venous thromboembolism under 45 years of age
  • Known thrombogenic mutations e.g. factor V Leiden, prothrombin mutation, protein S, protein C and antithrombin deficiencies
  • Cardiomyopathy with impaired cardiac function
  • Atrial fibrillation
  • Significant or prolonged immobility.
  • Imminent planned major surgery (COC should be stopped at least 4 weeks prior to planned major surgery or expected period of limited mobility).

Neurological Conditions

  • Current or past history of migraine with neurological symptoms including aura at any age
  • Migraine without aura, first attack when on method of contraception containing an estrogen


  • Past or current history of breast cancer
  • Undiagnosed breast mass (for initiation of method only)
  • Carrier of known gene mutations associated with breast cancer e.g. BRCA1or 2
  • Malignant liver tumour (hepatocellular carcinoma)

Gastro-intestinal Conditions

  • Viral hepatitis, acute or flare (for initiation only)
  • Severe decompensated cirrhosis
  • Gall bladder disease, symptomatic, medically treated
  • Gall bladder disease, currently symptomatic
  • Any bariatric or other surgery resulting in malabsorption.
  • Cholestasis (related to past combined hormonal contraceptive use)
  • Benign liver tumour (hepatocellular adenoma)

Other conditions

  • Diabetes with end organ disease (retinopathy, nephropathy, neuropathy)
  • Positive anti-phospholipid antibodies (with or without systemic lupus erythematosus)
  • Organ transplant, with complications
  • Individuals using enzyme-inducing drugs/herbal products or within 4 weeks of stopping them.
  • Known severe renal impairment or acute renal failure
  • Acute porphyria
Interacting medicines (other than enzyme inducers) – see current British National Formulary (BNF) or individual product SPC
  • breastfeeding - UKMEC score varies with respect to timing of use of combined hormonal contraception (2)