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

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36 MMWR June 18, 2010 TABLE. (Continued) Classifications for progestin-only contraceptives,* † including progestin-only pills, DMPA, and implants Condition b. Elevated blood pressure levels (properly taken measurements) i. Systolic 140–159 mm Hg or diastolic 90–99 mm Hg Category POP DMPA Implants Clarifications/Evidence/Comments 1 2 1 Evidence: Limited evidence suggests that among women with hypertension, those who used POPs or progestin-only ii. Systolic ≥160 mm Hg or 2 3 2 diastolic ≥100 mm Hg § injectables had a small increased risk for cardiovascular events than did women who did not use these methods (110). c. Vascular disease 2 3 2 Comment: Concern exists about hypo-estrogenic effects and reduced HDL levels, particularly among users of DMPA. However, there is little concern about these effects with regard to POPs. The effects of DMPA might persist for some time after discontinuation History of high blood pressure during pregnancy (where current blood pressure is measurable and normal) 1 1 1 Deep venous thrombosis (DVT)/ Pulmonary embolism (PE) a. History of DVT/PE, not on anticoagulant therapy i. Higher risk for recurrent DVT/ 2 2 2 PE (≥1 risk factors) • History of estrogen-associated DVT/PE • Pregnancy-associated DVT/PE • Idiopathic DVT/PE • Known thrombophilia, including antiphospholipid syndrome • Active cancer (metastatic, on therapy, or within 6 mos after clinical remission), excluding non-melanoma skin cancer • History of recurrent DVT/PE ii Lower risk for recurrent DVT/ 2 2 2 PE (no risk factors) b. Acute DVT/PE 2 2 2 Evidence: No direct evidence exists on use of POCs among women with acute DVT/PE. Although findings on the risk for venous thrombosis with use of POCs in otherwise healthy women is inconsistent, any small increased risk is substantially less than that with COCs (110–112). c. DVT/PE and established on anticoagulant therapy for at least 3 mos i. Higher risk for recurrent DVT/ 2 2 2 PE (≥1 risk factors) • Known thrombophilia, including antiphospholipid syndrome • Active cancer (metastatic, on therapy, or within 6 mos after clinical remission), excluding non-melanoma skin cancer • History of recurrent DVT/PE ii. Lower risk for recurrent DVT/ 2 2 2 PE (no risk factors) d. Family history 1 1 1 (first-degree relatives) e. Major surgery i. With prolonged immobilization 2 2 2 ii. Without prolonged 1 1 1 immobilization f. Minor surgery without 1 1 1 immobilization Evidence: No direct evidence exists on use of POCs among women with DVT/PE on anticoagulant therapy. Although findings on the risk for venous thrombosis with use of POCs are inconsistent in otherwise healthy women, any small increased risk is substantially less than that with COCs (110–112). Limited evidence indicates that intramuscular injections of DMPA in women on chronic anticoagulation therapy does not pose a significant risk for hematoma at the injection site or increase the risk for heavy or irregular vaginal bleeding (113).
Vol. 59 / RR-4 Recommendations and Reports 37 TABLE. (Continued) Classifications for progestin-only contraceptives,* † including progestin-only pills, DMPA, and implants Category Condition Known thrombogenic mutations § (e.g., factor V Leiden; prothrombin mutation; protein S, protein C, and antithrombin deficiencies) POP DMPA Implants Clarifications/Evidence/Comments 2 2 2 Clarification: Routine screening is not appropriate because of the rarity of the conditions and the high cost of screening. Superficial venous thrombosis a. Varicose veins 1 1 1 b. Superficial thrombophlebitis 1 1 1 Current and history of ischemic Initiation Continuation Initiation Continuation Comment: Concern exists about hypo-estrogenic effects heart disease § 2 3 3 2 3 and reduced HDL levels, particularly among users of DMPA. However, there is little concern about these effects with regard to POPs. The effects of DMPA might persist for some time after discontinuation. Stroke § (history of cerebrovascular accident) Initiation Continuation Initiation Continuation Comment: Concern exists about hypo-estrogenic effects 2 3 3 2 3 and reduced HDL levels, particularly among users of DMPA. However, there is little concern about these effects with regard to POPs. The effects of DMPA may persist for some time after discontinuation. Known hyperlipidemias 2 2 2 Clarification: Routine screening is not appropriate because of the rarity of the conditions and the high cost of screening. Some types of hyperlipidemias are risk factors for vascular disease. Valvular heart disease a. Uncomplicated 1 1 1 b. Complicated § (pulmonary hypertension, risk for atrial fibrillation, history of subacute bacterial endocarditis) 1 1 1 Peripartum cardiomyopathy § a. Normal or mildly impaired cardiac function (New York Heart Association Functional Class I or II: patients with no limitation of activities or patients with slight, mild limitation of activity) (114) i.
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CDC Article-US Medical Eligibility Criteria for Contraceptive Use, 2010

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