[Contraception in Women at Risk]

Contraception in Women at Risk Abstract. Healthy non-obese non-smokers without personal contraindications may use all hormonal and non-hormonal contraceptive methods up to the normal menopausal age. However, underlying diseases or an unfavourable lifestyle may change this liberty of choice. Vascular risks are potentiated by age, obesity, smoking, arterial hypertension, and diabetes. The presence of any arterial disease is an absolute contraindication against combined oral contraceptive (CHC). In regard of internal diseases, CHC possess the highest risk for serious complications among the methods known to be safe, whereas the lowest risk is seen in users of Cu-IUDs. The hormonal alternatives to CHC are gestagen-only preparations including levonorgestrel-releasing IUS. If no further pregnancies are intended, sterilisation of one of the partners is also a valid alternative. Because of their lack of reliability, barrier methods and natural family planning should be strongly discouraged in women with an underlying disease. Any unplanned pregnancy may present a high risk for mother and child. In presence of an underlying disease, it is strongly recommended to consult the treating specialist before a hormonal method is chosen. Independently of the method used, all women at risk for sexually transmitted diseases should also use a barrier method.