INITIATING CONTRACEPTION: MEDICAL ELIGIBILITY CRITERIA

Adapted from the CDC's U.S. Medical Eligibility Criteria for Contraceptive Use, 2010:
CDC U.S. Medical Eligiblity Criteria 2010

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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