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Appendix D

Classifications for Emergency Contraceptive Pills


Classifications for emergency contraceptive pills (ECPs) are for both levonorgestrel and combined oral contraceptive pills. ECPs do not protect against sexually transmitted infections (STIs) or human immunodeficiency virus (HIV).

BOX. Categories for Classifying Emergency Contraceptive Pills

1 = A condition for which there is no restriction for the use of the contraceptive method.

2 = A condition for which the advantages of using the method generally outweigh the theoretical or proven risks.

3 = A condition for which the theoretical or proven risks usually outweigh the advantages of using the method.

4 = A condition that represents an unacceptable health risk if the contraceptive method is used.


TABLE. Classifications for emergency contraceptive pills, including levonorgestrel contraceptive pills and combined oral contraceptive pills*

Condition

Category

Clarifications/Evidence/Comments

Personal Characteristics and Reproductive History

Pregnancy

Not applicable

Clarification: Although this method is not indicated for a woman with a known or suspected pregnancy, no harm to the woman, the course of her pregnancy, or the fetus if ECPs are inadvertently used is known to exist.

Breastfeeding

1

Past ectopic pregnancy

1

History of bariatric surgery§

a. Restrictive procedures: decrease storage capacity of the stomach (vertical banded gastroplasty, laparoscopic adjustable gastric band, laparoscopic sleeve gastrectomy)

1

b. Malabsorptive procedures: decrease absorption of nutrients and calories by shortening the functional length of the small intestine (Roux-en-Y gastric bypass, biliopancreatic diversion)

1

Comment: Bariatric surgical procedures involving a malabsorptive component have the potential to decrease oral contraceptive effectiveness, perhaps further decreased by postoperative complications such as long-term diarrhea and/or vomiting. Because of these malabsorptive concerns, an emergency IUD might be more appropriate than ECPs.

Cardiovascular Disease

History of severe cardiovascular complications§ (ischemic heart disease, cerebrovascular attack, or other thromboembolic conditions)

2

Comment: The duration of ECP use is less than that of regular use of COCs or POPs and thus would be expected to have less clinical impact.

Angina pectoris

2

Comment: The duration of ECP use is less than that of regular use of COCs or POPs and thus would be expected to have less clinical impact.

Rheumatic Diseases

Rheumatoid arthritis

a. On immunosuppressive therapy

1

b. Not on immunosuppressive therapy

1

Neurologic Conditions

Migraine

2

Comment: The duration of ECP use is less than that of regular use of COCs or POPs and thus would be expected to have less clinical impact.

Gastrointestinal Conditions

Inflammatory bowel disease (ulcerative colitis, Crohn disease)

1

Severe liver disease§ (including jaundice)

2

Comment: The duration of ECP use is less than that of regular use of COCs or POPs and thus would be expected to have less clinical impact.

Solid Organ Transplantation

Solid organ transplantation§

a. Complicated: graft failure (acute or chronic), rejection, cardiac allograft vasculopathy

1

b. Uncomplicated

1


TABLE. (Continued) Classifications for emergency contraceptive pills, including levonorgestrel contraceptive pills and combined oral contraceptive pills*

Condition

Category

Clarifications/Evidence/Comments

Other

Repeated ECP use

1

Clarification: Recurrent ECP use is an indication that the woman requires further counseling about other contraceptive options. Frequently repeated ECP use may be harmful for women with conditions classified as 2, 3, or 4 for CHC or POC use.

Rape

1

Comment: Use of ECPs in cases of rape has no restrictions.

* Abbreviations: STI = sexually transmitted infection; HIV = human immunodeficiency virus; ECP, emergency contraceptive pill; IUD = intrauterine device; COC = combined oral contraceptive; POP = progestin-only pill; CHC = combined hormonal contraceptive; POC = progestin-only contraceptive

ECPs do not protect against STI/HIV. If risk exists for STI/HIV (including during pregnancy or postpartum), the correct and consistent use of condoms is recommended, either alone or with another contraceptive method. Consistent and correct use of the male latex condom reduces the risk for STIs and HIV transmission.

§ Condition that exposes a woman to increased risk as a result of unintended pregnancy.



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