Several concerns arise with the use of non-condom contraception and medications used to treat this patient’s renal disease/SLE. In particular, several of her medications are known teratogens. Cyclophosphamide and enalapril are classified as pregnancy safety category D (positive evidence of human fetal risk), and hydroxychloroquine is classified as a pregnancy category C (animal studies show adverse fetal effects, but there are no controlled human studies) (see Table 22.2). Administration of a teratogenic medication should always warrant consideration of pregnancy risk. All sexually active adolescents and women are at risk for unplanned pregnancy, even when using a contraceptive method. In fact, 43% of adult women with unplanned pregnancies were using a contraceptive method (either inconsistently or incorrectly) when becoming pregnant [21]. This is also true for women taking known teratogenic medications. One study showed that 40% of women taking a teratogenic medication and COCs were taking their COC in a suboptimal frequency, threatening the efficacy [22]. As such, a contraceptive method with high efficacy and low user-dependent use error should be offered as a first-line method for adolescents and women taking teratogenic medications.