Particularly,  a report showed the occurrence of vena cava inferior thrombosis,renal vein thrombosis and pulmonary embolism due to inherited protein C deficiency in a 18-year old woman treated with HCs for three months ⁽¹⁴⁾.  Similarly,  cases of Budd-Chiari Syndrome in carriers of antithrombin III deficiency with a current or past history of oral contraceptive use had been reported ^(15,16). 

The   increase   in   blood   pressure   associated   with   HCs administration is generally mild and usually seen during the first or the second year of use.  It is prudent to monitor blood pressure at least every 6 months in women receiving combined hormonal contraceptives,  and it is mandatory in women over 35.

Furthermore, it is important to consider if the woman smokes or if she has some lipid anomalies.

In fact, women who take HCs have an increased risk of developing new hypertension,  which returns to baseline within 1 to 3 months of HC cessation ⁽¹⁷⁾. 

However,  some cases of irreversible hypertension, kidney failure and malignant nephrosclerosis have been reported ^(18,19). Women with pre-existing hypertension who take HCs have an increased risk of stroke and myocardial   infarction   when   compared   with   hypertensive   women   who   do not ⁽²⁰⁾.

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

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 are very effective,  have no metabolic side effects and merely carry a small risk of endocarditis. Newer devices containing progesterone only may put the patients at a still smaller risk. Contraceptive subdermal implants (e.g. levonorgestrel) are used with good results in the United States   for   patients   with   contraindications   to   estrogen-containing   oral contraceptives   ⁽²¹⁾. 

Smoking increases the risk of hypertension by some 2 to 3 times. Smoking increases the risk of vascular damage by increasing sympathetic tone,  platelet   stickness   and   reactivity,  free   radical   production,  damage   of endothelium, and by surges in arterial pressure ^(22,23). Almost 18% of the women suffering from migraine headaches and this data explains as the gynaecologyst will often be asked by their patients to prescribe hormonal contraceptives.

Several evidences showed that migraine is a contraindication to hormonal contraception in all women with aura and those aged 35 or older ⁽²⁴⁾.

The use of highly effective reversible contraceptives is important for women with health issue, yet sometimes those same illnesses make the contraceptives themselves less effective or less safe. Common conditions are: systemic lupus erytematosus,uncontrolled diabetes mellitus, anticonvulsivant use for epilepsy or mood disorders, HIV infection, migraine headache, and obesity ⁽²⁵⁾.

In addition, vitamin C in amounts of 1g/day has been found to intensify the action of contraceptives by enhancing systemic   estrogen   action. The   tuberculostatic   drug   rifampicin   reduces   the breakdown of estrogen and progestin components for oral contraceptives. Antibiotics   or   sulfonamides   seem   reduce   effectiveness   of contraceptives by slowing reabsorption of estrogens due to reduced intestinal microflora ^(26,27).