# Asymptomatic and mild illness not requiring hospitalization
There is currently no available evidence associating asymptomatic and mild COVID-19 illnesses not requiring hospitalization with an increased venous thromboembolism (VTE) risk. 1,2 In this context, any form of contraception, including estrogen-containing combined hormonal contraceptives, can be continued without modification.

# Moderate to severe illness requiring hospitalization
Moderate and severe COVID-19 illnesses requiring hospitalization are associated with an increased VTE risk, up to 17% incidence of any VTE and 7.1% incidence of pulmonary embolism (PE). 3 Study populations were often older, mostly male and had risk factors for VTE, limiting generalizability to healthy, reproductive age women. Current recommendations are to prophylactically anti-coagulate everyone hospitalized with a COVID-19 illness. 4 Non-hormonal contraceptives (copper intrauterine device) and progesterone-only methods of contraception (POP, LNG-IUS, DMPA and progestin implants) are not associated with an increased risk of VTE 5 and require no modification to their ongoing use in women with moderate to severe COVID-19 illness requiring hospitalization.
Combined oral contraceptives (COCs) are associated with a 2-to 3-fold increase in VTE compared to non-users, with the highest risk in the first year of use. 6 Baseline risk of VTE in reproductive age women not using COCs is 4-5/10,000-woman years, compared to 10/10,000 woman years in COC users. This is in comparison to the relative risk of 6.7 of VTE in pregnancy and 115.1 in the postpartum period. 6 Contextualizing this risk against the risk of a pregnancy complicated by COVID-19 illness is crucial. In pregnant women with a COVID-19 illness, current data show a 7-10% rate of ICU admission, 3.4% rate of mechanical ventilation and 1% maternal mortality rate. 7 The rate of VTE in pregnant women with COVID-19 is not established yet, with only a handful of case reports so far. 8,9,10,11 Given the elevated risk of VTE associated with pregnancy and postpartum compared to CHC use, as well as the risks of pregnancy complicated by COVID-19 illness, continued use of CHCs (pill, patch or ring) in women with moderate to severe COVID-19 illness requiring hospitalization represents a balanced harm reduction approach.
Women who are positive for COVID-19 illness with asymptomatic or mild illness can initiate any form of contraception, including combined hormonal contraceptives. Women who are positive for COVID-19 illness with moderate or severe illness requiring hospitalization can initiate non-hormonal or progesterone-only methods of contraception, with a transition to combined hormonal contraceptives (pill, patch, ring) at time of discharge, if desired.

# Asymptomatic and mild illness not requiring hospitalization
There is currently no available evidence associating asymptomatic and mild COVID-19 illnesses not requiring hospitalization with an increased venous thromboembolism (VTE) risk. 1,2 In this context, initiating any form of contraception, including estrogen-containing combined hormonal contraceptives, is safe. The usual Medical Eligibility Criteria for each method apply. As outlined earlier in this guideline, women initiating combined hormonal contraceptives (pill, patch, ring) who are otherwise at low risk of cardiovascular disease, can initiate without a blood pressure assessment. A blood pressure should be assessed as soon as it is clinically feasible.

# Moderate to severe illness requiring hospitalization
Non-hormonal contraceptives (copper intrauterine device) and progesterone-only methods of contraception (POP, LNG-IUS, DMPA and progestin implants) are not associated with an increased risk of VTE 5 and can be initiated in women with moderate to severe COVID-19 illness requiring hospitalization.
As outlined above, COC use is associated with a 2-to 3-fold increase in VTE risk from baseline, with the highest risk within the first year of use. While women with COVID-19 who have already initiated this as their chosen form of contraception may continue instead of stopping and re-starting CHCs, women who are choosing to initiate contraception at the time of moderate to severe COVID-19 illness requiring hospitalization should consider non-hormonal or progesterone-only methods first.
The risk of VTE associated with moderate to severe COVID-19 illness requiring hospitalization returns to baseline at discharge from hospital. 12 Current recommendations are to halt prophylactic anticoagulation at the time of discharge. 4,13 Given this return to baseline VTE risk, women desiring to initiate combined hormonal contraception or transition from another method can do so safely at this time.

# Women who are positive for COVID-19 infection can use any form of emergency contraception, regardless of illness severity.
There are no absolute contraindications to the use of emergency contraception aside from pregnancy and hypersensitivity. 14 Even women with contraindications to the use of CHCs can safely use hormonal EC methods. 14 Women with any severity of COVID-19 illness can safely use any of the currently available methods for emergency contraception in Canada.