In the absence of other adverse clinical conditions, COCs can be used until menopause. There is also some theoretical concern regarding the association between COC use up to 3 weeks postpartum and risk of thrombosis in the mother. In the first 6 months postpartum, use of COCs during breastfeeding diminishes the quantity of breast milk, decreases the duration of lactation, and may thereby adversely affect the growth of the infant. Blood coagulation and fibrinolysis are essentially normalized by three weeks postpartum. COCs provide protection against ectopic pregnancy.
Obesity is a risk factor for venous thromboembolism.
However, in some settings blood pressure measurements are unavailable. In many of these settings pregnancy morbidity and mortality risks are high, and COCs are one of the few methods widely available. In such settings, women should not be denied use of COCs simply because their blood pressure cannot be measured. Evaluation of cause and level of hypertension is recommended, as soon as feasible. For all categories of hypertension, classifications are based on the assumption that no other risk factors for cardiovascular disease exist.