CDC Article-US Medical Eligibility Criteria for Contraceptive Use, 2010

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MMWR The MMWR series of publications is published by the Office of Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention (CDC), U.S. Department of Health and Human Services, Atlanta, GA 30333. Suggested Citation: Centers for Disease Control and Prevention. [Title]. MMWR 2010;59(No. RR-#):[inclusive page numbers]. Centers for Disease Control and Prevention Thomas R. Frieden, MD, MPH Director Peter A. Briss, MD, MPH Acting Associate Director for Science James W. Stephens, PhD Office of the Associate Director for Science Stephen B. Thacker, MD, MSc Deputy Director for Surveillance, Epidemiology, and Laboratory Services Editorial and Production Staff Frederic E. Shaw, MD, JD Editor, MMWR Series Christine G. Casey, MD Deputy Editor, MMWR Series Teresa F. Rutledge Managing Editor, MMWR Series David C. Johnson Lead Technical Writer-Editor Karen L. Foster, MA Project Editor Martha F. Boyd Lead Visual Information Specialist Malbea A. LaPete Stephen R. Spriggs Terraye M. Starr Visual Information Specialists Quang M. Doan, MBA Phyllis H. King Information Technology Specialists Contents Introduction............................................................................... 1 Methods.................................................................................... 2 How to Use This Document......................................................... 2 Using the Categories in Practice............................................... 3 Recommendations for Use of Contraceptive Methods................. 3 Contraceptive Method Choice.................................................. 4 Contraceptive Method Effectiveness.......................................... 4 Unintended Pregnancy and Increased Health Risk...................... 4 Keeping Guidance Up to Date.................................................... 4 Appendices A. Summary of Changes from WHO MEC to U.S. MEC............. 7 B. Combined Hormonal Contraceptives................................... 11 C. Progestin-Only Contraceptives........................................... 34 D. Emergency Contraceptive Pills............................................ 50 E. Intrauterine Devices........................................................... 52 F. Copper IUDs for Emergency Contraception.......................... 64 G. Barrier Methods............................................................... 65 H. Fertility Awareness–Based Methods.................................... 71 I. Lactational Amenorrhea Method.......................................... 73 J. Coitus Interruptus (Withdrawal)........................................... 74 K. Sterilization...................................................................... 75 L. Summary of Hormonal Contraceptives and IUDs.................. 76 M. Potential Drug Interactions: Hormonal Contraceptives and Antiretroviral Drugs...................................................... 82 Abbreviations and Acronyms.................................................... 84 Participants............................................................................. 85 Editorial Board William L. Roper, MD, MPH, Chapel Hill, NC, Chairman Virginia A. Caine, MD, Indianapolis, IN Jonathan E. Fielding, MD, MPH, MBA, Los Angeles, CA David W. Fleming, MD, Seattle, WA William E. Halperin, MD, DrPH, MPH, Newark, NJ King K. Holmes, MD, PhD, Seattle, WA Deborah Holtzman, PhD, Atlanta, GA John K. Iglehart, Bethesda, MD Dennis G. Maki, MD, Madison, WI Patricia Quinlisk, MD, MPH, Des Moines, IA Patrick L. Remington, MD, MPH, Madison, WI Barbara K. Rimer, DrPH, Chapel Hill, NC John V. Rullan, MD, MPH, San Juan, PR William Schaffner, MD, Nashville, TN Anne Schuchat, MD, Atlanta, GA Dixie E. Snider, MD, MPH, Atlanta, GA John W. Ward, MD, Atlanta, GA
Vol. 59 / RR-4 Recommendations and Reports 1 U S. Medical Eligibility Criteria for Contraceptive Use, 2010 Adapted from the World Health Organization Medical Eligibility Criteria for Contraceptive Use, 4th edition Prepared by Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion Summary CDC created U.S. Medical Eligibility Criteria for Contraceptive Use, 2010, from guidance developed by the World Health Organization (WHO) and finalized the recommendations after consultation with a group of health professionals who met in Atlanta, Georgia, during February 2009. This guidance comprises recommendations for the use of specific contraceptive methods by women and men who have certain characteristics or medical conditions. The majority of the U.S. guidance does not differ from the WHO guidance and covers >60 characteristics or medical conditions. However, some WHO recommendations were modified for use in the United States, including recommendations about contraceptive use for women with venous thromboembolism, valvular heart disease, ovarian cancer, and uterine fibroids and for postpartum and breastfeeding women. Recommendations were added to the U.S. guidance for women with rheumatoid arthritis, history of bariatric surgery, peripartum cardiomyopathy, endometrial hyperplasia, inflammatory bowel disease, and solid organ transplantation. The recommendations in this document are intended to assist health-care providers when they counsel women, men, and couples about contraceptive method choice. Although these recommendations are meant to serve as a source of clinical guidance, health-care providers should always consider the individual clinical circumstances of each person seeking family planning services. Introduction In 1996, the World Health Organization (WHO) published the first edition of the Medical Eligibility Criteria for Contraceptive Use (MEC), which gave evidence-based guidance on the safety of contraceptive method use for women and men worldwide who had specific characteristics and medical conditions. Since that time, WHO has regularly updated its guidance on the basis of new evidence, and the WHO MEC is now in its fourth edition (1). CDC, through close collaboration with WHO, has contributed substantially during the last 15 years to creation of WHO’s global family planning guidance, which includes four documents: the medical eligibility criteria for contraceptive use, the selected practice recommendations for contraceptive use, a decision-making tool for clients and providers, and a global family planning handbook. This WHO guidance has been based on the best available scientific evidence, and CDC has served as the lead for establishing that evidence base and presenting the evidence to WHO for use during its expert working group meetings to create and update the guidance. WHO has always intended for its global guidance to be used by local or regional policy makers, managers of family planning Corresponding preparer: Kathryn M. Curtis, PhD, Division of Reproductive Health, CDC, MS K-34, 4770 Buford Highway NE, Atlanta, GA 30341; Telephone 770-488-6397; Fax: 770-488-6391; E-mail kmc6@cdc.gov programs, and the scientific community as a reference when they develop family planning guidance at the country or program level. The United Kingdom is one example of a country that has adapted the WHO MEC for its own use (2). CDC undertook a formal process to adapt the WHO MEC at this time because the fourth edition of the WHO guidance is unlikely to undergo major revisions in the near future. Although the WHO guidance is already available in the United States through inclusion in textbooks, use by professional organizations, and incorporation into training programs, the adaptation of the guidance ensures its appropriateness for use in the United States and allows for further dissemination and implementation among U.S. health-care providers. Most of the U.S. guidance does not differ from the WHO guidance and covers approximately 60 characteristics or medical conditions. However, several changes have been made, including adaptations of selected WHO recommendations, addition of recommendations for new medical conditions, and removal of recommendations for contraceptive methods not currently available in the United States (Appendix A). This document contains recommendations for health-care providers for the safe use of contraceptive methods by women and men with various characteristics and medical conditions. It is intended to assist health-care providers when they counsel women, men, and couples about contraceptive method choice. These recommendations are meant to be a source of clinical guidance; health-care providers should always consider the individual clinical circumstances of each person seeking family planning services.
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CDC Article-US Medical Eligibility Criteria for Contraceptive Use, 2010

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