Much of the woman’s dissatisfaction because of menstrual changes can be averted by careful counselling prior to method prescription.

Open dialogue explaining the potential for bleeding irregularities is crucial in this time, in order to avoid the discontinuation that places the woman at risk of unwilling pregnancy. The hormonal contraceptive prescription in some women at risk might be considered a hazard,  but an expert individualized evaluation of gynecologist may consent it.

Most women with congenital cardiac disease can safely use oral contraceptives, especially low-estrogen combinations or progestin-only preparations⁽⁸⁾.

Clearly, oral contraceptives should be avoided in all patients at particular risk of   thromboembolic   complications   because   of   pulmonary   hypertension, Eisenmenger syndrome, rhythm disturbances, reduced ventricular function, arterial hypertension,  infectious   complications   (endocarditis)  or   hyperlipidemia.

Intrauterine   devices-releasing   progestin   which   are   very   effective,  have   no metabolic side effects and merely carry a small risk of endocarditis⁽⁹⁾. 

Other medical conditions require our attention. During hormonal contraceptive use, some cases of subhepatic vein thrombosis or the Budd-Chiari syndrome, associated to focal nodular hyperplasia as well as adenoma have been reported^(10,11).

In the meantime, it is mandatory to avoid combined hormonal contraception in SLE patients with high levels of antiphospholipid antibodies and, in those with active nephritis^(12,13).

In fact, these women, when use combined oral contraceptives are at high risk of thromboses (St. Thomas’ Hospital-London) ^(12,13). Progress in the area of female reproduction is showing great promise for identifying new contraceptives drug targets ⁽¹⁴⁾.  Today, the properties of Selective progesterone receptor modulators (PRMs)  and progesterone antagonists(  PAs)  open up new applications   in   contraceptive   strategies   introducing   the   new   concept   of “Endometrial Contraception”⁽¹⁵⁾. 

In the meantime, there is necessity to develop newer, possibly nonsteroidal and non hormonal contraceptives. Recent advancements in our understanding of ovarian endocrinology, coupled with molecular biology and transgenic technology, have enabled identification of several factors that are functionally critical in the regulation of female fertility.