Understanding Contraindications: When Should You Not Take Birth Control Pills?

October 11, 2025 •

3 min read

With a typical use failure rate of 9%, oral contraceptive pills are a widely used method of birth control. However, they are not suitable for everyone. Knowing when should you not take birth control pills is crucial for your health and safety.

Quick Summary

Certain medical conditions, lifestyle factors, and medications make taking oral contraceptives unsafe. Key contraindications include a history of blood clots, specific cancers, uncontrolled high blood pressure, and smoking over age 35.

Key Points

Cardiovascular History: A personal history of blood clots, stroke, heart attack, or uncontrolled high blood pressure are major reasons not to take combination birth control pills.
Age and Smoking: Women aged 35 or older who smoke should not use combination pills due to a significantly increased risk of heart and blood vessel disease.
Specific Cancers: A current or past diagnosis of breast cancer is a contraindication for both combination and progestin-only pills.
Migraines with Aura: If you experience migraines with aura (sensory symptoms like seeing flashing lines), you should avoid estrogen-containing contraceptives.
Drug Interactions: Certain medications, including some anti-seizure drugs, antibiotics like rifampin, and St. John's Wort, can make birth control pills less effective.
Liver and Postpartum Risks: Severe liver disease and the immediate postpartum period (first 21 days) are also contraindications for combined hormonal pills.
Consult a Doctor: Always discuss your full medical history with a healthcare provider to determine the safest and most effective contraception method for you.

Birth control pills, also known as oral contraceptives, are a popular and effective method for preventing pregnancy and managing certain health issues. However, they are not a one-size-fits-all solution. For some individuals, the risks associated with the hormones in these pills, particularly estrogen, outweigh the benefits. Understanding the specific situations and medical conditions—known as contraindications—where birth control pills should be avoided is essential for making informed healthcare decisions. A healthcare provider must assess your personal medical history before prescribing any hormonal contraceptive.

Absolute Contraindications: When Combination Pills Are Unsafe

For some individuals, taking combination oral contraceptives (COCs), which contain both estrogen and progestin, poses an unacceptable health risk. These are known as absolute contraindications. The estrogen in these pills can increase the risk of blood clots, heart attack, and stroke.

Cardiovascular and Blood Clot Risks

One of the most significant concerns with COC use is the risk of venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism. Avoid COCs if you have a personal history of VTE, stroke, heart attack, or other serious heart problems. Uncontrolled hypertension (systolic blood pressure ≥160 mmHg or diastolic blood pressure ≥100 mmHg) is also an absolute contraindication. Additionally, women over 35 who smoke heavily (≥15 cigarettes per day) should not use combination pills due to a significantly increased risk of cardiovascular disease. Avoid COCs if you are facing major surgery with prolonged immobilization or have a history of migraine headaches with aura.

Cancer and Liver Conditions

Certain types of cancer and liver diseases are hormonally sensitive, making COCs an unsafe option. A current or past diagnosis of breast cancer is an absolute contraindication for both combination and progestin-only pills. Severe liver conditions, such as severe cirrhosis, liver tumors, or acute viral hepatitis, are also contraindications.

Other Absolute Contraindications

Other conditions that make COC use unsafe include pregnancy, the first 21 days after giving birth due to a higher VTE risk, diabetes with vascular complications or a duration over 20 years, and Systemic Lupus Erythematosus (SLE) with positive (or unknown) antiphospholipid antibodies.

Relative Contraindications and Progestin-Only Pills (POPs)

Relative contraindications are conditions where COC risks might outweigh benefits, requiring doctor evaluation. Progestin-only pills (POPs) may be a safer alternative due to fewer cardiovascular risks. Examples include being over 35 and smoking less than 15 cigarettes daily, having well-controlled high blood pressure, or breastfeeding. However, POPs are contraindicated with a history of breast cancer and certain liver diseases.


Contraindication Category	Combined Oral Contraceptives (COCs)	Progestin-Only Pills (POPs)	Safer Alternatives
Cardiovascular Risk	Unacceptable risk for those with history of blood clots, stroke, heart disease, or uncontrolled high blood pressure.	Generally considered a safer option as they don't contain estrogen.	Copper IUD, barrier methods (condoms, diaphragm).
Smokers >35 Years	Unacceptable risk, especially for heavy smokers (≥15 cigarettes/day).	Can often be used.	Implants, IUDs, barrier methods.
Migraine with Aura	Unacceptable risk at any age.	Generally considered a safer option.	Non-hormonal methods like the copper IUD.
Current Breast Cancer	Unacceptable risk.	Unacceptable risk.	Copper IUD, barrier methods.
Breastfeeding	Not recommended in the first 4-6 weeks postpartum as estrogen may reduce milk supply. Use with caution later.	Generally considered safe to use while breastfeeding.	Progestin-only methods, IUDs, barrier methods.

Drug Interactions

Certain medications and supplements can interfere with birth control pill effectiveness by altering hormone absorption and metabolism. This raises the risk of unintended pregnancy. Medications known to interact include some antibiotics (like rifampin), anti-seizure medications (such as carbamazepine, phenytoin, topiramate), antiretroviral drugs for HIV, and the herbal supplement St. John's Wort. Always inform your healthcare provider of all medications and supplements you take.

Conclusion: Prioritize a Doctor's Consultation

Oral contraceptives are a safe and effective option for many but not universally suitable. A thorough evaluation of your medical history, lifestyle, and medications is necessary to determine if they are right for you. Absolute contraindications, such as a history of blood clots or breast cancer, mean certain hormonal methods should be avoided. For relative contraindications, progestin-only or non-hormonal methods may be safer. Always consult a healthcare professional to discuss your risks and find the best contraceptive method for your needs.

For more information, consult the U.S. Medical Eligibility Criteria for Contraceptive Use from the Centers for Disease Control and Prevention (CDC).

Frequently Asked Questions

If you have uncontrolled high blood pressure, you should not take combination birth control pills. If your blood pressure is well-controlled, your doctor will weigh the risks and benefits, but a progestin-only pill or a non-hormonal method is often a safer choice.

If you are 35 or older and smoke, especially 15 or more cigarettes per day, you should not take combination birth control pills due to the high risk of heart attack and stroke. A progestin-only method or a non-hormonal option is recommended.

If you have a history of migraines with aura (symptoms like flashing lights or zigzag lines), you should not take combination birth control pills because of an increased risk of stroke. Migraines without aura may be acceptable, but you should discuss this with your doctor.

A side effect is a potential unwanted reaction, such as nausea, headaches, or breast tenderness, that can occur while taking a medication. A contraindication is a specific medical condition or factor that makes using a medication unacceptably dangerous. For example, nausea is a side effect, while a history of blood clots is a contraindication.

No, a current or past history of breast cancer is a contraindication for using both combination and progestin-only hormonal birth control pills.

There are many alternatives. Progestin-only methods include the minipill, the contraceptive implant, and the hormonal IUD. Non-hormonal options include the copper IUD, condoms, diaphragms, and cervical caps.

Yes, the herbal supplement St. John's wort is known to interfere with the effectiveness of birth control pills and should be avoided if you are relying on them for contraception.