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Coc-english - 19-july 2012

Checklist for Screening Clients Who Want to
Initiate Combined Oral Contraceptives (COC)
Assessing Medical Eligibility for COC
Research findings have established that combined oral contraceptives (COCs) are safe and effective for use by most women, including those who are at risk of sexually transmitted infections (STIs) and those living with or at risk of HIV infection. However, for some women, COCs are not recommended because of the presence of certain medical conditions, such as ischemic heart disease, stroke, and breast cancer. For this reason, women who want to use COCs must be screened before COCs are started. This screening checklist is based on the Medical Eligibility Criteria for Contraceptive Use and developed after review of research and evidence-based literature. It consists of 17 questions and provides guidance based on clients' responses. The first 6 questions enable providers to reasonably rule out pregnancy before initiating the method. The last 11 questions are designed to identify medical conditions. Clients excluded because of their response to the medical eligibility questions may still be good candidates for COC if the suspected contraindication or condition can be excluded through appropriate evaluation. Ask the client:
If yes, COCs can not be started because of the increased risk of stroke in these women. However, women with mild headaches can use COCs.
1. Did you give birth to a baby in the past four weeks?
2. Is your baby less than 6 months, and are you exclusively

11. Have you ever been told you have breast cancer?
breastfeeding (only your milk and no other animal milk, liquids or
food), and you have not had a menstrual period since giving birth?

If yes, COCs can not be started because breast cancer is a hormone- 3. Have you abstained from sexual intercourse since your last
sensitive tumor, and COC use may adversely affect the course of breast menstrual period, delivery, MTP or abortion?
4. Did your last menstrual period start within the past 5 days?
5. Have you had a miscarriage, abortion or medical termination of

12. Have you ever had a stroke, blood clot in your legs or lungs, or
pregnancy (MTP) in the last 7 days?
heart attack?
6. Have you been using a reliable contraceptive method consistently
and correctly?
If yes, COCs can not be started because there is an increased risk of blood clots.
If yes to any one of the questions 1-6, and there are no clinical signs of pregnancy, it is highly unlikely that she is pregnant. She can start COCs 13. Do you regularly take any pills such as rifampicin or rifabutin (for
immediately. No backup contraceptive method needed. t u b e r c u l o s i s ) , a n t i co nv u l s a n t s i n c l u d i n g p h e ny t o i n ,
carbamazepine, primidone, topiramate, oxcarbazepine,

If the client began her last menstrual period within the past 5 days, she lamotrigine, and barbiturates (for epilepsy/seizures), or ritonavir
can start COCs now. No back-up contraceptive protection is needed.
(for HIV)?
If the client began her last menstrual period more than 5 days ago, she If yes, COCs can not be started as these medications make COCs less can start taking COCs, but instruct her to also use condoms or abstain from sex for the next 7 days. Give her 8-10 condoms.
14. Do you have gall bladder disease, severe cirrhosis, malignant or
If you cannot determine with reasonable certainty that your client is benign liver tumors, serious liver disease or jaundice (yellow skin
not pregnant (using the checklist), and if you do not have access to a or eyes)?
pregnancy test, then instruct her to wait until her next menstrual period begins before starting COCs. Give her condoms to use in the If yes, CoCs can not be started because the hormones used in COCs are processed by the liver and may further compromise liver function. However, women with other liver problems, such as chronic hepatitis 7. Are you currently breastfeeding a baby less than six months of
or focal nodular hyperplasia can use COCs safely.
15. Have you ever been told you have high blood pressure?
If yes, delay COCs until her baby is older than 6 months because COC use diminishes the quantity of breast milk and can decrease the If yes, COCs can not be started because there is an increased risk of stroke and heart attack. These women need their blood pressure evaluated by a trained provider before starting COCs.
8. Have you given birth in the last 3 weeks ?
16. Have you ever been told you have diabetes, high blood sugar or
If yes, COC can not be started because it increases the risk of vascular complications?
If yes, COCs can not be started because of the increased risk of blood 9. Do you smoke cigarettes and are you more than 35 years of age?
clots. Evaluate as appropriate and, if these complications are absent, the woman can start COCs.
If yes to both the questions, COCs can not be started because the client may be at increased risk of cardiovascular disease and heart attack. 17. Have you ever been told that you have a rheumatic disease, such
However, women less than 35 years of age who smoke and women as lupus?
over 35 years of age who do not smoke can use COCs and are not at increased risk for cardiovascular disease. If yes, COCs can not be started because there is an increased risk of thrombosis unless she is on immunosuppresants.
10. Do you have migraines or headaches that are severe, repeat, often
on one side, pulsating, causing nausea, and made worse by light,
noise, or movement?

Revised and adapted by UHI in 2012 from checklist produced by USAID and FHI360 in 2008 Checklist for Screening Clients Who Want to
Initiate Combined Oral Contraceptives (COC)
Rule out pregnancy before providing COCs! Ask questions 1–6 to be reasonably sure that the client is not pregnant.
As soon as the client answers YES to any question, stop, and follow the instructions after question 6.

1. Did you give birth to a baby in the past 4 weeks? 2. Is your baby less than 6 months, and are you exclusively breastfeeding (only your milk and no other animal milk, liquids or food), and you have not had a menstrual period since giving birth? 3. Have you abstained from sexual intercourse since your last menstrual period, delivery, medical termination of pregnancy (MTP) or abortion? 4. Did your last menstrual period start within the past 5 days? 5. Have you had a miscarriage, abortion or medical termination of pregnancy (MTP) in the last 7 days? 6. Have you been using IUCD, DMPA, OCP or condoms consistently and correctly? If the client answered YES to any one of questions 1–6 and she is free of
If the client answered NO to all of
signs or symptoms of pregnancy, you can be reasonably sure that she is questions 1–6, she may be pregnant.
not pregnant. The client can start COCs now.
Wait until next menses or use pregnancy test to confirm non-pregnancy.
If the client began her last menstrual period within the past 5 days , she can start COCs immediately. No additional contraceptive protection is needed.
Give the women COCs but instruct her to start using them during the first 5 days of If the client began her last menstrual period more than 5 days ago, tell her to begin taking COCs now, but instruct her to use condoms or abstain from sex for the next 7 days. Give her condoms to use for the next 7 days.
Give her condoms to use in the meantime.
To determine if the client is medically eligible to use COCs, ask questions 7–17. As soon as the client answers YES to
any question, stop, and follow the instructions after question 17.
7. Are you currently breastfeeding a baby less than six months of age? 8. Have you given birth in the last 3 weeks? 9. Do you smoke cigarettes and are you more than 35 years of age? 10. Do you have migraines or headaches that are severe, repeat, often on one side, pulsating, causing nausea, and made worse by light, noise, or movement? 11. Have you ever been told you have breast cancer? 12. Have you ever had a stroke, blood clot in your legs or lungs, or heart attack? 13. Do you regularly take any pills such as rifampicin or rifabutin (for tuberculosis), anticonvulsants including phenytoin, carbamazepine, primidone, topiramate, oxcarbazepine, lamotrigine, and barbiturates (for epilepsy/seizures), or ritonavir (for HIV)? 14. Do you have gall bladder disease, severe cirrhosis, malignant or benign liver tumors, serious liver disease or jaundice (yellow skin or eyes)? 15. Have you ever been told you have high blood pressure? 16. Have you ever been told you have diabetes, high blood sugar or vascular complications? 17. Have you ever been told that you have a rheumatic disease such as lupus? If the client answered NO
If the client answered YES to any of questions 7–13, she is not a good
to all of questions 7–17,
candidate for COCs. Counsel her about other available methods or refer.
If the client answered YES to any of questions 14–17, COCs cannot be initiated
without further evaluation. Evaluate or refer as appropriate, and give condoms
to use in the meantime. See explanations and more instructions on the reverse side.
Revised and adapted by UHI in 2012 from checklist produced by USAID and FHI360 in 2008

Source: http://www.uhi-india.org.in/toolkits/coc/COC_Checklist_Eng.pdf

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