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

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70 MMWR June 18, 2010 TABLE. (Continued) Classifications for barrier methods,* † including condoms, spermicides, and diaphragms/caps Category Condition Condom Spermicide Diaphragm/ cap Clarifications/Evidence/Comments Drug Interactions Antiretroviral (ARV) therapy a. Nucleoside reverse transcriptase inhibitors 1 3 3 (NRTIs) b. Non-nucleoside reverse transcriptase 1 3 3 inhibitors (NNRTIs) c. Ritonavir-boosted protease inhibitors 1 3 3 Clarification: No drug interaction between ARV therapy and barrier method use is known. However, HIV infection and AIDS are classified as Category 3 for spermicides and diaphragms (see HIV/AIDS condition above). Anticonvulsant therapy a. Certain anticonvulsants (phenytoin, carbamazepine, 1 1 1 barbiturates, primidone, topiramate, oxcarbazepine) b. Lamotrigine 1 1 1 Antimicrobial therapy a. Broad-spectrum antibiotics 1 1 1 b. Antifungals 1 1 1 c. Antiparasitics 1 1 1 d. Rifampicin or rifabutin therapy 1 1 1 Allergy to latex 3 1 3 Clarification: The condition of allergy to latex does not apply to plastic condoms/ diaphragms. * Abbreviations: STI = sexually transmitted infection; HIV = human immunodeficiency virus; BMI, body mass index; DVT = deep venous thrombosis; PE = pulmonary embolism; ARV = antiretroviral; hCG = human chorionic gonadotropin; PID = pelvic inflammatory disease; AIDS = acquired immunodeficiency syndrome; COC = combined oral contraceptive; NRTI = nucleoside reverse transcriptase inhibitor; NNRTI = non-nucleoside reverse transcriptase inhibitor. † If risk exists for STI/HIV (including during pregnancy or postpartum), the correct and consistent use of condoms is recommended, either alone or with another contraceptive method. Consistent and correct use of the male latex condom reduces the risk for STIs and HIV transmission. Women with conditions that make pregnancy an unacceptable risk should be advised that barrier methods for pregnancy prevention may not be appropriate for those who cannot use them consistently and correctly because of the relatively higher typical-use failure rates of these methods. § Condition that exposes a woman to increased risk as a result of unintended pregnancy. References 1. The Criteria Committee of the New York Heart Association. Nomenclature and criteria for diagnosis of diseses of the heart and great vessels. 9th ed. Boston, MA: Little, Brown & Co; 1994. 2. Wilkinson D, Ramjee G, Tholandi M, Rutherford G. Nonoxynol-9 for preventing vaginal acquisition of HIV infection by women from men. Cochrane Database Syst Rev 2002;4:CD003939.
Vol. 59 / RR-4 Recommendations and Reports 71 Appendix H Classifications for Fertility Awareness–Based Methods Fertility awareness–based (FAB) methods of family planning involve identifying the fertile days of the menstrual cycle, whether by observing fertility signs such as cervical secretions and basal body temperature or by monitoring cycle days (Box). FAB methods can be used in combination with abstinence or barrier methods during the fertile time. If barrier methods are used, refer to Appendix G. No medical conditions become worse because of use of FAB methods. In general, FAB methods can be used without concern for health effects to persons who choose them. However, a number of conditions make their use more complex. The existence of these conditions suggests that 1) use of these methods should be delayed until the condition is corrected or resolved or 2) persons using FAB methods will require special counseling, and a more highly trained provider is generally necessary to ensure correct use. Women with conditions that make pregnancy an unacceptable risk should be advised that FAB methods might not be appropriate for them because of the relatively higher typical-use failure rates of these methods. FAB methods do not protect against sexually transmitted infections (STIs) or human immunodeficiency virus (HIV). Box. Definitions for terms associated with fertility awareness– based methods • Symptoms-based methods: FAB methods based on observation of fertility signs (e.g., cervical secretions, basal body temperature) such as the Cervical Mucus Method, the Symptothermal Method, and the TwoDay Method. • Calendar-based methods: FAB methods based on calendar calculations such as the Calendar Rhythm Method and the Standard Days Method. • Acccept (A): There is no medical reason to deny the particular FAB method to a woman in this circumstance. • Caution (C): The method is normally provided in a routine setting but with extra preparation and precautions. For FAB methods, this usually means that special counselling might be needed to ensure correct use of the method by a woman in this circumstance. • Delay (D): Use of this method should be delayed until the condition is evaluated or corrected. Alternative temporary methods of contraception should be offered. TABLE. Fertility awareness–based methods,* † including symptoms-based and calendar-based methods Condition Symptom-based method Personal Characteristics and Reproductive History Category Calendar-based method Clarifications/Evidence/Comments Pregnancy Not applicable Clarification: FAB methods are not relevant during pregnancy. Life stage a. Postmenarche C C b. Perimenopause C C Clarification: Menstrual irregularities are common in postmenarche and perimenopause and might complicate the use of FAB methods. Breastfeeding Comment: Use of FAB methods when breastfeeding might be less effective than when not breastfeeding. a.
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CDC Article-US Medical Eligibility Criteria for Contraceptive Use, 2010

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