Summary Chart of U.S. Medical Eligibility Criteria for ...

1 Summary Chart of Medical Eligibility Criteria for contraceptive Use Key: Updated June 2012. This Summary sheet only contains a subset of the recommendations from the US MEC. For complete guidance, see: 1 No restriction (method can be used) 2 Advantages generally outweigh theoretical or proven risks 3 Theoretical or proven risks usually outweigh the advantages Most contraceptive methods do not protect against sexually transmitted infections (STIs). Consistent and correct use of the male latex 4 Unacceptable health risk (method not to be used) condom reduces the risk of STIs and HIV. Progestin-only pill Progestin-only pill Combined pill, Sub-condition Combined pill, Sub-condition Copper-IUD. Copper-IUD.

2 Patch, ring LNG--IUD. patch, ring Condition LNG--IUD. Condition Injection Injection Implant Implant I C I C I C I C I C I C I C I C I C I C I C I C. Age Menarche Menarche to Menarche to Menarche to Menarche to Menarche to Diabetes mellitus (i) non-insulin dependent 2 2 2 2 2 1. to <40=1 <18=1 <18=2 <18=1 <20=2 <20=2 (cont.) (ii) insulin dependent 2 2 2 2 2 1. >40=2 18-45=1 18-45=1 18-45=1 >20=1 >20=1 c) Nephropathy/ retinopathy/ 3/4* 2 3 2 2 1. >45=1 >45=2 >45=1 neuropathy . Anatomic a) Distorted uterine cavity 4 4 d) Other vascular disease or 3/4* 2 3 2 2 1. abnormalities b) Other abnormalities 2 2 diabetes of >20 years' duration . Anemias a) Thalassemia 1 1 1 1 1 2 Endometrial 1 1 1 1 4 2 4 2. b) Sickle cell disease 2 1 1 1 1 2 cancer.

3 C) Iron-deficiency anemia 1 1 1 1 1 2 Endometrial 1 1 1 1 1 1. Benign ovarian (including cysts) 1 1 1 1 1 1 hyperplasia tumors Endometriosis 1 1 1 1 1 2. Breast disease a) Undiagnosed mass 2* 2* 2* 2* 2 1 Epilepsy (see also Drug Interactions) 1* 1* 1* 1* 1 1. b) Benign breast disease 1 1 1 1 1 1 Gallbladder a) Symptomatic c) Family history of cancer 1 1 1 1 1 1 disease (i) treated by 2 2 2 2 2 1. d) Breast cancer cholecystectomy i) current 4 4 4 4 4 1 (ii) medically treated 3 2 2 2 2 1. ii) past and no evidence of 3 3 3 3 3 1 (iii) current 3 2 2 2 2 1. current disease for 5 years b) Asymptomatic 2 2 2 2 2 1. Breastfeeding a) < 1 month postpartum 3* 2* 2* 2* Gestational a) Decreasing or 1 1 1 1 3 3.

4 (see also b) 1 month or more postpartum 2* 1* 1* 1* trophoblastic undetectable -hCG levels Postpartum) disease b) Persistently elevated 1 1 1 1 4 4. Cervical cancer Awaiting treatment 2 1 2 2 4 2 4 2 -hCG levels or Cervical ectropion 1 1 1 1 1 1 malignant disease . Cervical 2 1 2 2 2 1 Headaches a) Non-migrainous 1* 2* 1* 1* 1* 1* 1* 1* 1* 1* 1*. intraepithelial b) Migraine neoplasia Cirrhosis a) Mild (compensated) i) without aura, age <35 2* 3* 1* 2* 2* 2* 2* 2* 2* 2* 1*. 1 1 1 1 1 1. b) Severe (decompensated) ii) without aura, age >35 3* 4* 1* 2* 2* 2* 2* 2* 2* 2* 1*. 4 3 3 3 3 1. Deep venous a) History of DVT/PE, not on iii) with aura, any age 4* 4* 2* 3* 2* 3* 2* 3* 2* 3* 1*. thrombosis anticoagulant therapy History of a) Restrictive procedures 1 1 1 1 1 1.

5 (DVT) i) higher risk for recurrent 4 2 2 2 2 1 bariatric b) Malabsorptive procedures COCs: 3 3 1 1 1 1. /Pulmonary DVT/PE surgery . P/R: 1. embolism (PE) ii) lower risk for recurrent 3 2 2 2 2 1 History of a) Pregnancy-related 2 1 1 1 1 1. DVT/PE. cholestasis b) Past COC-related 3 2 2 2 2 1. b) Acute DVT/PE 4 2 2 2 2 2. History of high 2 1 1 1 1 1. c) DVT/PE and established on blood pressure anticoagulant therapy for at least 3. during pregnancy months i) higher risk for recurrent 4* 2 2 2 2 2 History of pelvic 1 1 1 1 1 1. DVT/PE surgery ii) lower risk for recurrent 3* 2 2 2 2 2 HIV High risk 1 1 1* 1 2 2 2 2. DVT/PE HIV infected 1* 1* 1* 1* 2 2 2 2. d) Family history (first-degree 2 1 1 1 1 1 (see also Drug Interactions).

6 Relatives) AIDS 1* 1* 1* 1* 3 2* 3 2*. e) Major surgery (see also Drug Interactions) . Clinically well on therapy If on treatment, see Drug Interactions 2 2 2 2. (i) with prolonged 4 2 2 2 2 1. immobilization Hyperlipidemias 2/3* 2* 2* 2* 2* 1*. (ii) without prolonged 2 1 1 1 1 1 Hypertension a) Adequately controlled 3* 1* 2* 1* 1 1. immobilization hypertension f) Minor surgery without 1 1 1 1 1 1 b) Elevated blood pressure levels immobilization (properly taken measurements). Depressive 1* 1* 1* 1* 1* 1* (i) systolic 140-159 or diastolic 3 1 2 1 1 1. disorders 90-99. Diabetes mellitus a) History of gestational DM only 1 1 1 1 1 1 (ii) systolic 160 or diastolic 4 2 3 2 2 1. (DM) 100 . b) Non-vascular disease c) Vascular disease 4 2 3 2 2 1.

7 Progestin-only pill Progestin-only pill Combined pill, Combined pill, Sub-condition Sub-condition Copper-IUD. Copper-IUD. patch, ring patch, ring LNG--IUD. LNG--IUD. Condition Condition Injection Injection Implant Implant I C I C I C I C I C I C I C I C I C I C I C I C. Inflammatory (Ulcerative colitis, Crohn's 2/3* 2 2 1 1 1 Sexually c) Vaginitis (including 1 1 1 1 2 2 2 2. bowel disease disease) transmitted trichomonas vaginalis and Ischemic heart Current and history of 4 2 3 3 2 3 2 3 1 infections bacterial vaginosis). disease (cont.) d) Increased risk of STIs 1 1 1 1 2/3* 2 2/3* 2. Liver tumors a) Benign Smoking a) Age < 35 2 1 1 1 1 1. i) Focal nodular hyperplasia 2 2 2 2 2 1 b) Age > 35, < 15 cigarettes/day 3 1 1 1 1 1.

8 Ii) Hepatocellular adenoma 4 3 3 3 3 1 c) Age > 35, >15 cigarettes/day 4 1 1 1 1 1. b) Malignant 4 3 3 3 3 1 Solid organ a) Complicated 4 2 2 2 3 2 3 2. Malaria 1 1 1 1 1 1 transplantation b) Uncomplicated 2* 2 2 2 2 2. Multiple risk (such as older age, smoking, 3/4* 2* 3* 2* 2 1 Stroke History of cerebrovascular 4 2 3 3 2 3 2 1. factors for arterial diabetes and hypertension) accident cardiovascular Superficial a) Varicose veins 1 1 1 1 1 1. disease venous b) Superficial thrombophlebitis 2 1 1 1 1 1. Obesity a) >30 kg/m2 body mass index 2 1 1 1 1 1 thrombosis (BMI). b) Menarche to < 18 years and > 2 1 2 1 1 1 Systemic lupus a) Positive (or unknown) 4 3 3 3 3 3 1 1. 30 kg/m2 BMI erythematosus antiphospholipid antibodies Ovarian cancer b) Severe thrombocytopenia 2 2 3 2 2 2* 3* 2*.

9 1 1 1 1 1 1. Parity a) Nulliparous c) Immunosuppressive treatment 2 2 2 2 2 2 2 1. 1 1 1 1 2 2. b) Parous d) None of the above 2 2 2 2 2 2 1 1. 1 1 1 1 1 1. Past ectopic Thrombogenic 4* 2* 2* 2* 2* 1*. 1 2 1 1 1 1. pregnancy mutations . Pelvic a) Past, (assuming no current risk Thyroid disorders Simple goiter/ 1 1 1 1 1 1. inflammatory factors of STIs) hyperthyroid/hypothyroid disease (i) with subsequent pregnancy 1 1 1 1 1 1 1 1 Tuberculosis a) Non-pelvic 1* 1* 1* 1* 1 1. (see also Drug b) Pelvic 1* 1* 1* 1* 4 3 4 3. (ii) without subsequent 1 1 1 1 2 2 2 2 Interactions). pregnancy Unexplained (suspicious for serious condition) 2* 2* 3* 3* 4* 2* 4* 2*. b) Current 1 1 1 1 4 2* 4 2* vaginal bleeding before evaluation Peripartum a) Normal or mildly impaired Uterine fibroids 1 1 1 1 2 2.

10 Cardiomyopathy cardiac function Valvular heart a) Uncomplicated 2 1 1 1 1 1. (i) < 6 months 4 1 1 1 2 2 disease b) Complicated 4 1 1 1 1 1. (ii) > 6 months 3 1 1 1 2 2 Vaginal a) Irregular pattern without heavy 1 2 2 2 1 1 1. b) Moderately or severely 4 2 2 2 2 2 bleeding bleeding impaired cardiac function patterns b) Heavy or prolonged bleeding 1* 2* 2* 2* 1* 2* 2*. Postabortion a) First trimester 1* 1* 1* 1* 1* 1* Viral hepatitis a) Acute or flare 3/4* 2 1 1 1 1 1. b) Second trimester 1* 1* 1* 1* 2 2 b) Carrier/Chronic 1 1 1 1 1 1 1. c) Immediately post-septic 1* 1* 1* 1* 4 4 Drug Interactions abortion Antiretroviral a) Nucleoside reverse 1* 1 1 1 2/3* 2* 2/3* 2*. Postpartum a) < 21 days 4 1 1 1 therapy transcriptase inhibitors (see also b) 21 days to 42 days Breastfeeding) b) Non-nucleoside reverse 2* 2* 1 2* 2/3* 2* 2/3* 2*.