A new study has shown that new generations of oral contraceptives may be safer than the early high-dose formulations.
However, all the risks and benefits are yet to be established.
"Health care providers must evaluate each woman's risk factors, especially those related to cardiovascular health, prior to starting any contraceptive therapy," said Dr. Chrisandra L. Shufelt, assistant director of the Women's Heart Center at the Cedars-Sinai Heart Institute.
"Although pre-menopausal women have a much lower risk of cardiovascular disease, routine screening for potential problems and follow-up is important," she added.
The earlier contraceptives used higher levels of oestrogen than the newer formulations, which are now available not only in pill form but in patches and vaginal rings.
The newer formulations use lower doses of oestrogen, which is safer in terms of lowering the risk of blood clots, and they tend to use a progestin, a synthetic version of progesterone that is not likely to raise blood pressure and may even slightly reduce it.
According to the researchers, any woman considering the use of contraceptives should be evaluated for cholesterol levels, blood pressure, smoking, diabetes, kidney problems, obesity and other vascular diseases, including migraines.
Healthy, non-smoking women aged 35 or more can continue taking a low dose oral contraceptive until 50 to 55 years after reviewing the risks and benefits.
The report appears in the Journal of the American College of Cardiology.