ABSTRACT
It is impossible for the Boxes immediately above to list every known disease which might have a bearing (i.e. WHO 4, 3 or 2) on COC prescription, and for many the data are unavailable. A working rule therefore is to ascertain whether or not the condition might lead to summation with known major adverse effects of COCs, particularly with the risk of any circulatory disease; this usually means WHO 4, sometimes 3. If it won’t summate, in most serious chronic conditions the patient can be reassured that COCs are not known to have any effect, good or bad; they may then be used (WHO 2), though with the most careful monitoring and alertness for the onset of new risk factors. Reliable protection from pregnancy is often particularly important when other diseases are present, though we do now have new EE-free choices (e.g. Cerazette, Implanon, IUDs and the IUS).
