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



640080-914407773035-91440Summary Chart of U.S. Medical Eligibility Criteria for Contraceptive UseKey:1 No restriction (method can be used)2 Advantages generally outweigh theoretical or proven risks3 Theoretical or proven risks usually outweigh the advantages4 Unacceptable health risk (method not to be used)Updated June 2012. This summary sheet only contains a subset of the recommendations from the US MEC. For complete guidance, see: contraceptive methods do not protect against sexually transmitted infections (STIs). Consistent and correct use of the male latex condom reduces the risk of STIs and HIV.ConditionSub-condition Combined pill, patch, ringProgestin-only pillInjectionImplantLNG--IUDCopper-IUDICICICICICICAgeMenarche to <40=1Menarche to <18=1Menarche to <18=2Menarche to <18=1Menarche to <20=2Menarche to <20=2>40=218-45=118-45=118-45=1>20=1>20=1>45=1>45=2>45=1Anatomicabnormalities a) Distorted uterine cavity44b) Other abnormalities22Anemiasa) Thalassemia111112b) Sickle cell disease?211112c) Iron-deficiency anemia111112Benign ovarian tumors(including cysts)111111Breast diseasea) Undiagnosed mass2*2*2*2*21b) Benign breast disease111111c) Family history of cancer111111d) Breast cancer? i) current444441ii) past and no evidence of current disease for 5 years333331Breastfeeding(see also Postpartum)a) < 1 month postpartum3*2*2*2*b) 1 month or more postpartum2*1*1*1*Cervical cancerAwaiting treatment21224242Cervical ectropion111111Cervical intraepithelial neoplasia 212221Cirrhosisa) Mild (compensated)111111b) Severe? (decompensated)433331Deep venous thrombosis (DVT) /Pulmonary embolism (PE)a) History of DVT/PE, not on anticoagulant therapyi) higher risk for recurrent DVT/PE 422221ii) lower risk for recurrent DVT/PE 322221b) Acute DVT/PE422222c) DVT/PE and established on anticoagulant therapy for at least 3 monthsi) higher risk for recurrent DVT/PE 4*22222ii) lower risk for recurrent DVT/PE 3*22222d) Family history (first-degree relatives)211111e) Major surgery(i) with prolonged immobilization422221(ii) without prolonged immobilization211111f) Minor surgery without immobilization111111Depressive disorders1*1*1*1*1*1*Diabetes mellitus (DM) a) History of gestational DM only111111b) Non-vascular diseaseDiabetes mellitus (cont.)(i) non-insulin dependent222221(ii) insulin dependent?222221c) Nephropathy/ retinopathy/ neuropathy?3/4*23221d) Other vascular disease or diabetes of >20 years' duration?3/4*23221Endometrial cancer?11114242Endometrial hyperplasia111111Endometriosis 111112Epilepsy?(see also Drug Interactions)1*1*1*1*11Gallbladder diseasea) Symptomatic(i) treated by cholecystectomy222221 (ii) medically treated322221(iii) current322221b) Asymptomatic222221Gestational trophoblastic diseasea) Decreasing orundetectable ?-hCG levels111133b) Persistently elevated?-hCG levels ormalignant disease?111144Headachesa) Non-migrainous1*2*1*1*1*1*1*1*1*1*1*b) Migrainei) without aura, age <352*3*1*2*2*2*2*2*2*2*1*ii) without aura, age >353*4*1*2*2*2*2*2*2*2*1*iii) with aura, any age4*4*2*3*2*3*2*3*2*3*1*History of bariatric surgery?a) Restrictive procedures111111b) Malabsorptive proceduresCOCs: 331111P/R: 1History of a) Pregnancy-related211111cholestasisb) Past COC-related 322221History of high blood pressure during pregnancy 211111History of pelvic surgery111111HIV High risk111*12222HIV infected (see also Drug Interactions)?1*1*1*1*2222AIDS (see also Drug Interactions) ?1*1*1*1*32*32*Clinically well on therapyIf on treatment, see Drug Interactions2222Hyperlipidemias2/3*2*2*2*2*1*Hypertension a) Adequately controlled hypertension3*1*2*1*11b) Elevated blood pressure levels (properly taken measurements)(i) systolic 140-159 or diastolic 90-99312111(ii) systolic ≥160 or diastolic ≥100?423221c) Vascular disease423221Inflammatory bowel disease(Ulcerative colitis, Crohn’s disease)2/3*22111Ischemic heart disease?Current and history of423323231Liver tumorsa) Benigni) Focal nodular hyperplasia222221ii) Hepatocellular adenoma?433331b) Malignant?433331Malaria111111Multiple risk factors for arterial cardiovascular disease(such as older age, smoking, diabetes and hypertension)3/4*2*3*2*21Obesitya) >30 kg/m2 body mass index (BMI)211111b) Menarche to < 18 years and > 30 kg/m2 BMI212111Ovarian cancer?111111Paritya) Nulliparous111122b) Parous111111Past ectopic pregnancy121111Pelvic inflammatory diseasea) Past, (assuming no current risk factors of STIs)(i) with subsequent pregnancy11111111(ii) without subsequent pregnancy11112222b) Current111142*42*Peripartum cardiomyopathy? a) Normal or mildly impaired cardiac function(i) < 6 months411122(ii) > 6 months311122b) Moderately or severely impaired cardiac function422222Postabortiona) First trimester1*1*1*1*1*1*b) Second trimester1*1*1*1*22c) Immediately post-septic abortion1*1*1*1*44Postpartum (see also Breastfeeding)a) < 21 days4111b) 21 days to 42 days (i) with other risk factors for VTE3*111(ii) without other risk factors for VTE2111c) > 42 days1111Postpartum (in breastfeeding or non-breastfeeding women, includingpost-cesareansection)a) < 10 minutes after delivery of the placenta21b) 10 minutes after delivery of the placenta to < 4 weeks22c) > 4 weeks11d) Puerperal sepsis44Pregnancy NA*NA*NA*NA*4*4*Rheumatoid arthritisa) On immunosuppressive therapy212/3*12121b) Not on immunosuppressive therapy212111Schistosomiasisa) Uncomplicated111111b) Fibrosis of the liver?111111Severe dysmenorrhea111112Sexually transmitted infections (STIs)Sexually transmitted infections (cont.)a) Current purulent cervicitis or chlamydial infection or gonorrhea111142*42*b) Other STIs (excluding HIV and hepatitis)11112222c) Vaginitis (including trichomonas vaginalis and bacterial vaginosis)11112222d) Increased risk of STIs11112/3*22/3*2Smokinga) Age < 35211111b) Age > 35, < 15 cigarettes/day311111c) Age > 35, >15 cigarettes/day411111Solid organ transplantation?a) Complicated42223232b) Uncomplicated2*22222Stroke?History of cerebrovascular accident42332321Superficial venousthrombosisa) Varicose veins111111b) Superficial thrombophlebitis211111Systemic lupus erythematosus?a) Positive (or unknown) antiphospholipid antibodies43333311b) Severe thrombocytopenia223222*3*2*c) Immunosuppressive treatment22222221d) None of the above22222211Thrombogenic mutations?4*2*2*2*2*1*Thyroid disordersSimple goiter/ hyperthyroid/hypothyroid111111Tuberculosis? (see also Drug Interactions)a) Non-pelvic1*1*1*1*11b) Pelvic1*1*1*1*4343Unexplained vaginal bleeding (suspicious for serious condition) before evaluation2*2*3*3*4*2*4*2*Uterine fibroids111122Valvular heart diseasea) Uncomplicated211111b) Complicated?411111Vaginal bleedingpatternsa) Irregular pattern without heavy bleeding1222111b) Heavy or prolonged bleeding1*2*2*2*1*2*2*Viral hepatitisa) Acute or flare3/4*211111b) Carrier/Chronic1111111Drug InteractionsAntiretroviral therapy a) Nucleoside reversetranscriptase inhibitors1*1112/3*2*2/3*2*b) Non-nucleoside reversetranscriptase inhibitors2*2*12*2/3*2*2/3*2*c) Ritonavir-boosted proteaseinhibitors 3*3*12*2/3*2*2/3*2*Anticonvulsant therapya) Certain anticonvulsants(phenytoin, carbamazepine,barbiturates, primidone,topiramate, oxcarbazepine)3*3*12*11b) Lamotrigine3*11111Antimicrobial therapya) Broad spectrum antibiotics111111b) Antifungals111111c) Antiparasitics111111d) Rifampicin or rifabutin therapy3*3*12*11I = initiation of contraceptive method; C = continuation of contraceptive method; NA = Not applicable* Please see the complete guidance for a clarification to this classification: reproductivehealth/unintendedpregnancy/USMEC.htm? Condition that exposes a woman to increased risk as a result of unintended pregnancy. ................
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