INITIATING CONTRACEPTION: MEDICAL ELIGIBILITY CRITERIA
Adapted from:
WHO Medical Eligiblity Criteria 2010
www.who.int/reproductivehealth/publications/family_planning/9789241563888/en/
and
CDC Medical Eligiblity Criteria 2010 including 2012 updates
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr59e0528a1.htm?s_cid=rr59e0528a1_e
These contraceptive methods do not protect against sexually transmitted infections (STIs). Condoms should be used to protect against STIs.
WHO Medical Eligiblity Criteria 2010
www.who.int/reproductivehealth/publications/family_planning/9789241563888/en/
and
CDC Medical Eligiblity Criteria 2010 including 2012 updates
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr59e0528a1.htm?s_cid=rr59e0528a1_e
These contraceptive methods do not protect against sexually transmitted infections (STIs). Condoms should be used to protect against STIs.
| Risk Level | Description |
|---|---|
| 1 | Method can be used without restriction |
| 2 | Advantages generally outweigh theoretical or proven risks |
| 3 | Method not usually recommended unless other, more appropriate methods are not available or not acceptable |
| 4 | Method not to be used |
| Condition | Qualifier for condition | Estrogen/ progestin: pill, patch, ring | Progestin-only: pill | Progestin-only: injection | Progestin-only: implant | Progestin IUD | Copper IUD |
|---|---|---|---|---|---|---|---|
| Anemia | Thalassemia | 1 | 1 | 1 | 1 | 1 | 2 |
| Sickle cell disease | 2 | 1 | 1 | 1 | 1 | 2 | |
| Iron-deficiency anemia | 1 | 1 | 1 | 1 | 1 | 2 | |
| Bariatric surgery | Stomach restrictive procedures, including lap band | 1 | 1 | 1 | 1 | 1 | 1 |
| Malabsorptive procedures, including gastric bypass | Pill:3 | 3 | 1 | 1 | 1 | 1 | |
| Patch or ring:1 | |||||||
| Breast cancer | Family history of cancer | 1 | 1 | 1 | 1 | 1 | 1 |
| Current | 4 | 4 | 4 | 4 | 4 | 1 | |
| In past, no evidence of disease for > 5 years | 3 | 3 | 3 | 3 | 3 | 1 | |
| Breast problems, benign | Undiagnosed mass | 2 | 2 | 2 | 2 | 2 | 1 |
| Benign breast disease | 1 | 1 | 1 | 1 | 1 | 1 | |
| Cervical cancer | Cervical intraepithelial neoplasia | 2 | 1 | 2 | 2 | 2 | 1 |
| Cancer, Awaiting treatment | 2 | 1 | 2 | 2 | 4 | 4 | |
| Depression | 1 | 1 | 1 | 1 | 1 | 1 | |
| Diabetes mellitus (DM) | History of gestational DM only | 1 | 1 | 1 | 1 | 1 | 1 |
| DM without vascular disease | 2 | 2 | 2 | 2 | 2 | 1 | |
| DM with end-organ damage or > 20 years duration | 3 | 2 | 3 | 2 | 2 | 1 | |
| Drug interactions | NRTI Antiretrovirals | 1 | 1 | 1 | 1 | If well:2 | If well:2 |
| If ill:3 | If ill:3 | ||||||
| NNRTI Antiretrovirals | 2 | 2 | 1 | 2 | If well:2 | If well:2 | |
| If ill:3 | If ill:3 | ||||||
| Protease inhibitors | 3 | 3 | 1 | 2 | If well:2 | If well:2 | |
| If ill:3 | If ill:3 | ||||||
| Anticonvulsants: phenytoin, carbamazepine, barbiturates, primidone, topiramate, oxcarbazepine | 3 Must select a pill with ≥ 30 mcg of estrogen to maximize efficacy |
3 | 1 | 2 | 1 | 1 | |
| Lamotrigine alone (Lamotrigine/valproate combo does not interact with hormones) | 3 Must select a pill with ≥ 30 mcg of estrogen to maximize efficacy |
1 | 1 | 1 | 1 | 1 | |
| Rifampin/rifabutin | 3 | 3 | 1 | 2 | 1 | 1 | |
| All other antibiotics & antifungals | 1 | 1 | 1 | 1 | 1 | 1 | |
| Endometrial cancer | 1 | 1 | 1 | 1 | 4 | 4 | |
| Endometriosis | 1 | 1 | 1 | 1 | 1 | 2 | |
| Gallbladder disease | Asymptomatic gallstones | 2 | 2 | 2 | 2 | 2 | 1 |
| Symptomatic gallstones, without cholecystectomy | 3 | 2 | 2 | 2 | 2 | 1 | |
| Hx of Pregnancy-related cholestasis | 2 | 1 | 1 | 1 | 1 | 1 | |
| Hx of hormone-related cholestasis | 3 | 2 | 2 | 2 | 2 | 1 | |
| Headaches | Non-migranous | 1 | 1 | 1 | 1 | 1 | 1 |
| Headaches: migraines | Without aura, age < 35 | 2 | 1 | 2 | 2 | 2 | 1 |
| Without aura, age > 35 | 3 | 1 | 2 | 2 | 2 | 1 | |
| With aura, any age | 4 | 2 | 2 | 2 | 2 | 1 | |
| HIV infection | High risk or HIV+ | 1 | 1 | 1 | 1 | 2 | 2 |
| AIDS (without drug interactions) | 1 | 1 | 1 | 1 | 3 | 3 | |
| Hypertension | During prior pregnancy only – now resolved | 2 | 1 | 1 | 1 | 1 | 1 |
| Systolic < 140-159 & diastolic < 90-99 | 3 | 1 | 2 | 1 | 1 | 1 | |
| Systolic > 160, diastolic > 100, or with vascular disease | 4 | 2 | 3 | 2 | 2 | 1 | |
| Inflammatory bowel disease | Ulcerative colitis, Crohn’s disease | 2 | 2 | 2 | 1 | 1 | 1 |
| Ischemic heart disease | Past or current | 4 | 2 | 3 | 2 | 2 | 1 |
| Liver Disease | Viral hepatitis-carrier | 1 | 1 | 1 | 1 | 1 | 1 |
| Viral hepatitis-active | 4 | 1 | 1 | 1 | 1 | 1 | |
| Cirrhosis-mild | 1 | 1 | 1 | 1 | 1 | 1 | |
| Cirrhosis-severe | 4 | 3 | 3 | 3 | 3 | 1 | |
| Tumors-focal nodular hyperplasia | 2 | 2 | 2 | 2 | 2 | 1 | |
| Hepatocellular adenoma | 4 | 3 | 3 | 3 | 3 | 1 | |
| Tumors-malignant | 4 | 3 | 3 | 3 | 3 | 1 | |
| Obesity | BMI > 30 kg/meter squared | 2 | 1 | 1 | 1 | 1 | 1 |
| Ovarian cancer | 1 | 1 | 1 | 1 | 1 | 1 | |
| Ovarian cysts & benign tumors | 1 | 1 | 1 | 1 | 1 | 1 | |
| Pelvic inflammatory disease | Past, with subsequent pregnancy | 1 | 1 | 1 | 1 | 1 | 1 |
| Past, without subsequent pregnancy | 1 | 1 | 1 | 1 | 2 | 2 | |
| Current | 1 | 1 | 1 | 1 | 4 | 4 | |
| Postpartum & breastfeeding After 21 days risk based on possible effects on milk production |
< 21 days | 4 | 1 | 1 | 1 | See Postpartum IUDs | |
| 21 days to 42 days | 3 | 1 | 1 | 1 | |||
| > 42 days | 2 | 1 | 1 | 1 | |||
| Postpartum, not breastfeeding Restrictions are based on risk of blood clots postpartum, independent of breast feeding |
< 21 days | 4 | 1 | 1 | 1 | See Postpartum IUDs | |
| 21 to 42 days - Risk Factors for VTE | 3 | 1 | 1 | 1 | |||
| 21 to 42 days - NO Risk Factors for VTE | 2 | 1 | 1 | 1 | |||
| > 42 days | 1 | 1 | 1 | 1 | |||
| Postpartum IUDs Breastfeeding or not breastfeeding |
< 10 minutes post-placenta delivery | N/A | 2 | 1 | |||
| up to 4 weeks | N/A | 2 | 2 | ||||
| > 4 weeks | N/A | 1 | 1 | ||||
| Rheumatoid arthritis | On immunosuppressive therapy | 2 | 1 | 2 | 1 | 2 | 2 |
| Not on immunosuppressive therapy | 2 | 1 | 2 | 1 | 1 | 1 | |
| Post-abortion | First trimester | 1 | 1 | 1 | 1 | 1 | 1 |
| Second trimester | 1 | 1 | 1 | 1 | 2 | 2 | |
| Immediately after septic abortion | 1 | 1 | 1 | 1 | 4 | 4 | |
| Sexually Transmitted Infections | Vaginitis | 1 | 1 | 1 | 1 | 2 | 2 |
| Increased risk for STIs *CDC-WHO classify these as 2/3. Current data suggests that IUDs can be inserted in women without clinical STIs and screened during insertion; if positive they can be treated with IUD in place |
1 | 1 | 1 | 1 | 2* | 2* | |
| Current GC/Chlamydia/Purulent cervicitis | 1 | 1 | 1 | 1 | 4 | 4 | |
| Smoking | Age < 35 | 2 | 1 | 1 | 1 | 1 | 1 |
| Age > 35, < 15 cigarettes/day | 3 | 1 | 1 | 1 | 1 | 1 | |
| Age > 35, > 15 cigarettes/day | 4 | 1 | 1 | 1 | 1 | 1 | |
| Seizure disorder | Without drug interactions | 1 | 1 | 1 | 1 | 1 | 1 |
| Stroke | Past or current | 4 | 2 | 3 | 2 | 2 | 1 |
| Surgery | Minor | 1 | 1 | 1 | 1 | 1 | 1 |
| Major, without prolonged immobilization | 2 | 1 | 1 | 1 | 1 | 1 | |
| Major, with prolonged immobilization | 4 | 2 | 3 | 2 | 2 | 1 | |
| Systemic lupus erythematosis | Antiphospholipid Ab+ unknown | 4 | 3 | 3 | 3 | 3 | 1 |
| Severe thrombocytopenia | 2 | 2 | 3 | 2 | 2 | 3 | |
| Immunosuppressive tx | 2 | 2 | 2 | 2 | 2 | 2 | |
| None of the above | 2 | 2 | 2 | 2 | 2 | 1 | |
| Thyroid disorders | Simple goiter, hyperthyroidism, hypothyroidism | 1 | 1 | 1 | 1 | 1 | 1 |
| Uterine fibroids | IUDs ok unless fibroids block insertion | 1 | 1 | 1 | 1 | 1 | 1 |
| Valvular heart disease | Uncomplicated | 2 | 1 | 1 | 1 | 1 | 1 |
| Complicated | 4 | 1 | 1 | 1 | 1 | 1 | |
| Varicose veins | 1 | 1 | 1 | 1 | 1 | 1 | |
| Venous thrombosis | Family history (1st-degree relatives) | 2 | 1 | 1 | 1 | 1 | 1 |
| Superficial thrombophlebitis | 2 | 1 | 1 | 1 | 1 | 1 | |
| Past DVT | 4 | 2 | 2 | 2 | 2 | 1 | |
| Current DVT | 4 | 2 | 2 | 2 | 2 | 2 | |