U.S. Selected Practice Recommendations for Contraceptive ...

1 Continuing Education Examination available at Recommendations and Reports / Vol. 65 / No. 4 July 29, 2016 Selected Practice Recommendations for Contraceptive Use, Department of Health and Human ServicesCenters for disease control and PreventionMorbidity and Mortality Weekly ReportRecommendations and ReportsCONTENTS (Continued)Disclosure of RelationshipCDC, our planners, and our content experts wish to disclose they have no financial interest or other relationships with the manufacturers of commercial products, suppliers of commercial services , or commercial supporters. Planners have reviewed content to ensure there is no bias. This document will not include any discussion of the unlabeled use of a product or a product under investigational use, with the exception that some of the Recommendations in this document might be inconsistent with package labeling.

2 The MMWR series of publications is published by the center for Surveillance, Epidemiology, and Laboratory services , centers for disease control and prevention (CDC), Department of Health and Human services , Atlanta, GA citation: [Author names; first three, then et al., if more than six.] [Title]. MMWR Recomm Rep 2016;65(No. RR-#):[inclusive page numbers].Centers for disease control and PreventionThomas R. Frieden, MD, MPH, Director Harold W. Jaffe, MD, MA, Associate Director for Science Joanne Cono, MD, ScM, Director, Office of Science Quality Chesley L. Richards, MD, MPH, Deputy Director for Public Health Scientific ServicesMichael F. Iademarco, MD, MPH, Director, center for Surveillance, Epidemiology, and Laboratory services MMWR Editorial and Production Staff (Serials)Sonja A.

3 Rasmussen, MD, MS, Editor-in-ChiefCharlotte K. Kent, PhD, MPH, Executive Editor Christine G. Casey, MD, EditorTeresa F. Rutledge, Managing EditorDavid C. Johnson, Lead Technical Writer-EditorCatherine B. Lansdowne, MS, Project EditorMartha F. Boyd, Lead Visual Information SpecialistMaureen A. Leahy, Julia C. Martinroe, Stephen R. Spriggs, Moua Yang, Tong Yang,Visual Information SpecialistsQuang M. Doan, MBA, Phyllis H. King, Terraye M. Starr,Information Technology SpecialistsMMWR Editorial BoardTimothy F. Jones, MD, ChairmanMatthew L. Boulton, MD, MPHV irginia A. Caine, MD Katherine Lyon Daniel, PhDJonathan E. Fielding, MD, MPH, MBAD avid W. Fleming, MD William E. Halperin, MD, DrPH, MPHKing K. Holmes, MD, PhD Robin Ikeda, MD, MPH Rima F. Khabbaz, MDPhyllis Meadows, PhD, MSN, RNJewel Mullen, MD, MPH, MPAJeff Niederdeppe, PhDPatricia Quinlisk, MD, MPH Patrick L.

4 Remington, MD, MPH Carlos Roig, MS, MAWilliam L. Roper, MD, MPH William Schaffner, MDCONTENTSI ntroduction ..1 Summary of Changes from the 2013 SPR ..2 Methods ..2 Maintaining Updated Guidance ..3 How To Use This Document ..3 Contraceptive Method Choice ..4 How To Be Reasonably Certain that a Woman Is Not Pregnant ..5 Intrauterine Contraception ..7 Implants ..14 Injectables ..18 Combined Hormonal Contraceptives ..22 Progestin-Only Pills ..31 Standard Days Method ..34 Emergency Contraception ..34 Female Sterilization ..36 Male Sterilization ..37 When Women Can Stop Using Contraceptives ..38 Conclusion ..39 References ..41 Appendix A: Summary Chart of Medical Eligibility Criteria for Contraceptive Use, 2016 ..53 Appendix B: When To Start Using Specific Contraceptive Methods.

5 62 Appendix C: Examinations and Tests Needed Before Initiation of Contraceptive Methods ..63 Appendix D: Routine Follow-Up After Contraceptive Initiation ..64 Appendix E: Management of Women with Bleeding Irregularities While Using Contraception ..65 Appendix F: Management of Intrauterine Devices When Users are Found To Have Pelvic Inflammatory disease ..66 Recommendations and ReportsMMWR / July 29, 2016 / Vol. 65 / No. 4 1US Department of Health and Human services /Centers for disease control and PreventionCorresponding author: Kathryn M. Curtis, PhD, Division of Reproductive Health, National center for Chronic disease prevention and Health Promotion, CDC. Telephone: 770-488-5200; E-mail: Selected Practice Recommendations for Contraceptive Use, 2016 Kathryn M.

6 Curtis, PhD1 Tara C. Jatlaoui, MD1 Naomi K. Tepper, MD1 Lauren B. Zapata, PhD1 Leah G. Horton, MSPH1 Denise J. Jamieson, MD1 Maura K. Whiteman, PhD11 Division of Reproductive Health, National center for Chronic disease prevention and Health PromotionSummaryThe 2016 Selected Practice Recommendations for Contraceptive Use ( SPR) addresses a select group of common, yet sometimes controversial or complex, issues regarding initiation and use of specific Contraceptive methods. These Recommendations for health care providers were updated by CDC after review of the scientific evidence and consultation with national experts who met in Atlanta, Georgia, during August 26 28, 2015. The information in this report updates the 2013 SPR (CDC. Selected Practice Recommendations for Contraceptive use, 2013.)

7 MMWR 2013;62[No. RR-5]). Major updates include 1) revised Recommendations for starting regular contraception after the use of emergency Contraceptive pills and 2) new Recommendations for the use of medications to ease insertion of intrauterine devices. The Recommendations in this report are intended to serve as a source of clinical guidance for health care providers and provide evidence-based guidance to reduce medical barriers to contraception access and use. Health care providers should always consider the individual clinical circumstances of each person seeking family planning services . This report is not intended to be a substitute for professional medical advice for individual patients. Persons should seek advice from their health care providers when considering family planning pregnancy rates remain high in the United States; approximately 45% of all pregnancies are unintended, with higher proportions among adolescent and young women, women who are racial/ethnic minorities, and women with lower levels of education and income (1).

8 Unintended pregnancies increase the risk for poor maternal and infant outcomes (2) and in 2010, resulted in government health care expenditures of $21 billion (3). Approximately half of unintended pregnancies are among women who were not using contraception at the time they became pregnant; the other half are among women who became pregnant despite reported use of contraception (4). Strategies to prevent unintended pregnancy include assisting women at risk for unintended pregnancy and their partners with choosing appropriate Contraceptive methods and helping them use methods correctly and consistently to prevent 2013, CDC published the first Selected Practice Recommendations for Contraceptive Use ( SPR), adapted from global guidance developed by the World Health Organization (WHO SPR), which provided evidence-based guidance on how to use Contraceptive methods safely and effectively once they are deemed to be medically appropriate.

9 SPR is a companion document to Medical Eligibility Criteria for Contraceptive Use ( MEC) ( ), which provides Recommendations on safe use of Contraceptive methods for women with various medical conditions and other characteristics (5). WHO intended for the global guidance to be used by local or national policy makers, family planning program managers, and the scientific community as a reference when they develop family planning guidance at the country or program level. During 2012 2013, CDC went through a formal process to adapt the global guidance for best implementation in the United States, which included rigorous identification and critical appraisal of the scientific evidence through systematic reviews, and input from national experts on how to translate that evidence into Recommendations for health care providers (6).

10 At that time, CDC committed to keeping this guidance up to date and based on the best available evidence, with full review every few years (6).This document updates the 2013 SPR (6) with new evidence and input from experts. Major updates include 1) revised Recommendations for starting regular contraception after the use of emergency Contraceptive pills and 2) new Recommendations for the use of medications to ease insertion of intrauterine devices (IUDs). Recommendations are provided for health care providers on the safe and effective use of Contraceptive methods and address provision of Contraceptive methods and management of side effects and other problems Recommendations and Reports2 MMWR / July 29, 2016 / Vol.