GynPraxis Dr. Sara
Checklist: Combined hormonal contraception (CHC)
Checklist: Combined hormonal contraception (CHC)
Click through or print before a first prescription or renewal.
Checklist (optional)
This online version is a free-form summary of the SGGG checklist. It is for preparation and does not replace medical advice.
Please let us know if any of the following applies
Smoking (especially age 35+)
Migraine (especially with aura) or new severe headaches
High blood pressure or blood pressure medication
History of thrombosis/embolism (personal or close family)
Known clotting disorder
Planned major surgery or prolonged immobilisation (e.g., cast, bed rest)
Diabetes, very high blood lipids or severe liver disease
Breast cancer or another hormone‑dependent condition (please specify briefly)
Breastfeeding or recent pregnancy/birth (please specify timing)
Medications/supplements that may affect effectiveness (e.g., certain anti‑seizure medicines, St. John’s wort)
Helpful for the appointment
Current medication list (incl. herbal products)
Last menstrual period / cycle (if known)
Questions/preferences about cycle control and alternatives (IUD, implant, ring/patch)
Source
Original document (PDF):
SGGG – CHC checklist for first prescription/renewal
Tip: If you are unsure whether something is relevant, mark it – we can clarify it together.