No Combined Hormonal Contraceptives Early PP: Regardless of their breastfeeding status, women who are less than 21 days post partum should not use combined hormonal contraception because of the high risk for venous thromboembolism. Previously, the guidelines recommended that women less than 21 days post partum “generally should not use combined hormonal contraceptives.” After 21 days, combined hormonal contraceptives could be used with no restrictions.
The revised guidelines now recommend that nonbreastfeeding women who are 21–42 days post partum and have other risk factors for venous thromboembolism generally not use combined hormonal contraceptives. These risk factors include age of 35 years or more, previous VTE, thrombophilia, immobility, transfusion at delivery, body mass index of 30 kg/m2 or more, postpartum hemorrhage, post–cesarean delivery, preeclampsia, or smoking. There are no restrictions for combined hormonal contraceptive use in women who are more than 42 days PP (MMWR 2011;60:878–83).
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