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Appendix A: Summary Chart of U.S. Medical Eligibility Criteria for Contraceptive Use, 2010

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Key:
1. No restriction (method can be used)
2. Advantages generally outweigh theoretical or proven risks
3. Theoretical or proven risks usually outweigh the advantages
4. 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: http://www.cdc.gov/reproductivehealth/
unintendedpregnancy/USMEC.htm
.

Most 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.

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Condition

Sub-condition

Combined pill, patch, ring

Progestin-only pill

Injection

Implant

LNG-IUD

Copper-IUD

I

C

I

C

I

C

I

C

I

C

I

C

Age

Menarche to <40=1

Menarche to <18=1

Menarche to <18=2

Menarche to <18=1

Menarche to <20=2

Menarche to <20=2

>40=2

18-45=1

18-45=1

18-45=1

>20=1

>20=1

>45=1

>45=2

>45=1

Anatomic
abnormalities

a) Distorted uterine cavity

4

4

b) Other abnormalities

2

2

Anemias

a) Thalassemia

1

1

1

1

1

2

b) Sickle cell disease

2

1

1

1

1

2

c) Iron-deficiency anemia

1

1

1

1

1

2

Benign ovarian tumors

(including cysts)

1

1

1

1

1

1

Breast disease

a) Undiagnosed mass

2*

2*

2*

2*

2

1

b) Benign breast disease

1

1

1

1

1

1

c) Family history of cancer

1

1

1

1

1

1

d) Breast cancer

i) current

4

4

4

4

4

1

ii) past and no evidence of current disease for 5 years

3

3

3

3

3

1

Breastfeeding
(see also Postpartum)

a) < 1 month postpartum

3*

2*

2*

2*

b) 1 month or more postpartum

2*

1*

1*

1*

Cervical cancer

Awaiting treatment

2

1

2

2

4

2

4

2

Cervical ectropion

1

1

1

1

1

1

Cervical
intraepithelial
neoplasia

2

1

2

2

2

1


Appendix A (Continued): Summary Chart of U.S. Medical Eligibility Criteria for Contraceptive Use, 2010

Condition

Sub-condition

Combined pill, patch, ring

Progestin-only pill

Injection

Implant

LNG-IUD

Copper-IUD

I

C

I

C

I

C

I

C

I

C

I

C

Cirrhosis

a) Mild (compensated)

1

1

1

1

1

1

b) Severe (decompensated)

4

3

3

3

3

1

DVT/PE

a) History of DVT/PE, not on anticoagulant therapy

i) higher risk for recurrent DVT/PE

4

2

2

2

2

1

ii) lower risk for recurrent DVT/PE

3

2

2

2

2

1

b) Acute DVT/PE

4

2

2

2

2

2

c) DVT/PE and established on anticoagulant therapy for at least 3 months

i) higher risk for recurrent DVT/PE

4*

2

2

2

2

2

ii) lower risk for recurrent DVT/PE

3*

2

2

2

2

2

d) Family history (first-degree relatives)

2

1

1

1

1

1

e) Major surgery

(i) with prolonged immobilization

4

2

2

2

2

1

(ii) without prolonged immobilization

2

1

1

1

1

1

f) Minor surgery without immobilization

1

1

1

1

1

1

Depressive disorders

1*

1*

1*

1*

1*

1*


Appendix A (Continued): Summary Chart of U.S. Medical Eligibility Criteria for Contraceptive Use, 2010

Condition

Sub-condition

Combined pill, patch, ring

Progestin-only pill

Injection

Implant

LNG-IUD

Copper-IUD

I

C

I

C

I

C

I

C

I

C

I

C

Diabetes mellitus

a) History of gestational diabetes mellitus only

1

1

1

1

1

1

b) Non-vascular disease

(i) non-insulin dependent

2

2

2

2

2

1

(ii) insulin dependent

2

2

2

2

2

1

c) Nephropathy/ retinopathy/ neuropathy

3/4*

2

3

2

2

1

d) Other vascular disease or diabetes of >20 years' duration

3/4*

2

3

2

2

1

Endometrial cancer

1

1

1

1

4

2

4

2

Endometrial
hyperplasia

1

1

1

1

1

1

Endometriosis

1

1

1

1

1

2

Epilepsy

(see also Drug Interactions)

1*

1*

1*

1*

1

1

Gallbladder disease

a) Symptomatic

(i) treated by cholecystectomy

2

2

2

2

2

1

(ii) medically treated

3

2

2

2

2

1

(iii) current

3

2

2

2

2

1

b) Asymptomatic

2

2

2

2

2

1

Gestational
trophoblastic disease

a) Decreasing or undetectable ß-hCG levels

1

1

1

1

3

3

b) Persistently elevated ß-hCG levels or malignant disease

1

1

1

1

4

4

Headaches

a) Non-migrainous

1*

2*

1*

1*

1*

1*

1*

1*

1*

1*

1*

b) Migraine

i) without aura, age <35

2*

3*

1*

2*

2*

2*

2*

2*

2*

2*

1*

ii) without aura, age >35

3*

4*

1*

2*

2*

2*

2*

2*

2*

2*

1*

iii) with aura, any age

4*

4*

2*

3*

2*

3*

2*

3*

2*

3*

1*


Appendix A (Continued): Summary Chart of U.S. Medical Eligibility Criteria for Contraceptive Use, 2010

Condition

Sub-condition

Combined pill, patch, ring

Progestin-only pill

Injection

Implant

LNG-IUD

Copper-IUD

I

C

I

C

I

C

I

C

I

C

I

C

History of bariatric surgery

a) Restrictive procedures

1

1

1

1

1

1

b) Malabsorptive procedures

COCs: 3

3

1

1

1

1

P/R: 1

History of cholestasis

a) Pregnancy-related

2

1

1

1

1

1

b) Past COC-related

3

2

2

2

2

1

History of high blood pressure
during pregnancy

2

1

1

1

1

1

History of pelvic surgery

1

1

1

1

1

1

HIV

High risk

1

1

1*

1

2

2

2

2

HIV infected (see also Drug Interactions)

1*

1*

1*

1*

2

2

2

2

AIDS (see also Drug Interactions)

1*

1*

1*

1*

3

2*

3

2*

Clinically well on therapy

If on treatment, see Drug Interactions

2

2

2

2

Hyperlipidemias

2/3*

2*

2*

2*

2*

1*

Hypertension

a) Adequately controlled hypertension

3*

1*

2*

1*

1

1

b) Elevated blood pressure levels (properly taken measurements)

(i) systolic 140-159 or diastolic 90-99

3

1

2

1

1

1

(ii) systolic ≥160 or diastolic ≥100

4

2

3

2

2

1

c) Vascular disease

4

2

3

2

2

1

Inflammatory bowel disease

(Ulcerative colitis, Crohn's disease)

2/3*

2

2

1

1

1

Ischemic heart
disease

Current and
history of

4

2

3

3

2

3

2

3

1

Liver tumors

a) Benign

i) Focal nodular hyperplasia

2

2

2

2

2

1

ii) Hepatocellular adenoma

4

3

3

3

3

1

b) Malignant

4

3

3

3

3

1

Malaria

1

1

1

1

1

1


Appendix A (Continued): Summary Chart of U.S. Medical Eligibility Criteria for Contraceptive Use, 2010

Condition

Sub-condition

Combined pill, patch, ring

Progestin-only pill

Injection

Implant

LNG-IUD

Copper-IUD

I

C

I

C

I

C

I

C

I

C

I

C

Multiple risk factors for arterial cardiovascular disease

(such as older age, smoking, diabetes and hypertension)

3/4*

2*

3*

2*

2

1

Obesity

a) >30 kg/m2 BMI

2

1

1

1

1

1

b) Menarche to <18 years and >30 kg/m2 BMI

2

1

2

1

1

1

Ovarian cancer

1

1

1

1

1

1

Parity

a) Nulliparous

1

1

1

1

2

2

b) Parous

1

1

1

1

1

1

Past ectopic
pregnancy

1

2

1

1

1

1

Pelvic inflammatory disease

a) Past, (assuming no current risk factors of STIs)

(i) with subsequent pregnancy

1

1

1

1

1

1

1

1

(ii) without subsequent pregnancy

1

1

1

1

2

2

2

2

b) Current

1

1

1

1

4

2*

4

2*

Peripartum cardiomyopathy

a) Normal or mildly impaired cardiac function

(i) <6 months

4

1

1

1

2

2

(ii) >6 months

3

1

1

1

2

2

b) Moderately or severely impaired cardiac function

4

2

2

2

2

2

Postabortion

a) First trimester

1*

1*

1*

1*

1*

1*

b) Second trimester

1*

1*

1*

1*

2

2

c) Immediately post-septic abortion

1*

1*

1*

1*

4

4

Postpartum
(see also Breastfeeding)

a) <21 days

4

1

1

1

b) 21 days to 42 days

(i) with other risk factors for VTE

3*

1

1

1

(ii) without other risk factors for VTE

2

1

1

1

c) >42 days

1

1

1

1


Appendix A (Continued): Summary Chart of U.S. Medical Eligibility Criteria for Contraceptive Use, 2010

Condition

Sub-condition

Combined pill, patch, ring

Progestin-only pill

Injection

Implant

LNG-IUD

Copper-IUD

I

C

I

C

I

C

I

C

I

C

I

C

Postpartum (in breastfeeding or non-breastfeeding women, including post-cesarean section)

a) <10 minutes after delivery of the placenta

2

1

b) 10 minutes after delivery of the placenta to < 4 weeks

2

2

c) >4 weeks

1

1

d) Puerperal sepsis

4

4

Pregnancy

NA*

NA*

NA*

NA*

4*

4*

Rheumatoid
arthritis

a) On immunosuppressive therapy

2

1

2/3*

1

2

1

2

1

b) Not on immunosuppressive therapy

2

1

2

1

1

1

Schistosomiasis

a) Uncomplicated

1

1

1

1

1

1

b) Fibrosis of the liver

1

1

1

1

1

1

Severe dysmenorrhea

1

1

1

1

1

2

STIs

a) Current purulent cervicitis or chlamydial infection or gonorrhea

1

1

1

1

4

2*

4

2*

b) Other STIs (excluding HIV and hepatitis)

1

1

1

1

2

2

2

2

c) Vaginitis (including trichomonas vaginalis and bacterial vaginosis)

1

1

1

1

2

2

2

2

d) Increased risk of STIs

1

1

1

1

2/3*

2

2/3*

2

Smoking

a) Age <35

2

1

1

1

1

1

b) Age >35, <15 cigarettes/day

3

1

1

1

1

1

c) Age >35, >15 cigarettes/day

4

1

1

1

1

1

Solid organ
transplantation

a) Complicated

4

2

2

2

3

2

3

2

b) Uncomplicated

2*

2

2

2

2

2

Stroke

History of cerebrovascular accident

4

2

3

3

2

3

2

1


Appendix A (Continued): Summary Chart of U.S. Medical Eligibility Criteria for Contraceptive Use, 2010

Condition

Sub-condition

Combined pill, patch, ring

Progestin-only pill

Injection

Implant

LNG-IUD

Copper-IUD

I

C

I

C

I

C

I

C

I

C

I

C

Superficial venous thrombosis

a) Varicose veins

1

1

1

1

1

1

b) Superficial thrombophlebitis

2

1

1

1

1

1

Systemic lupus
erythematosus

a) Positive (or unknown) antiphospholipid antibodies

4

3

3

3

3

3

1

1

b) Severe thrombocytopenia

2

2

3

2

2

2*

3*

2*

c) Immunosuppressive treatment

2

2

2

2

2

2

2

1

d) None of the above

2

2

2

2

2

2

1

1

Thrombogenic
mutations

4*

2*

2*

2*

2*

1*

Thyroid disorders

Simple goiter/ hyperthyroid/hypothyroid

1

1

1

1

1

1

Tuberculosis
(see also Drug
Interactions)

a) Non-pelvic

1*

1*

1*

1*

1

1

b) Pelvic

1*

1*

1*

1*

4

3

4

3

Unexplained vaginal bleeding

(suspicious for serious condition) before evaluation

2*

2*

3*

3*

4*

2*

4*

2*

Uterine fibroids

1

1

1

1

2

2

Valvular heart
disease

a) Uncomplicated

2

1

1

1

1

1

b) Complicated

4

1

1

1

1

1

Vaginal bleeding
patterns

a) Irregular pattern without heavy bleeding

1

2

2

2

1

1

1

b) Heavy or prolonged bleeding

1*

2*

2*

2*

1*

2*

2*

Viral hepatitis

a) Acute or flare

3/4*

2

1

1

1

1

1

b) Carrier/Chronic

1

1

1

1

1

1

1


Appendix A (Continued): Summary Chart of U.S. Medical Eligibility Criteria for Contraceptive Use, 2010

Condition

Sub-condition

Combined pill, patch, ring

Progestin-only pill

Injection

Implant

LNG-IUD

Copper-IUD

I

C

I

C

I

C

I

C

I

C

I

C

Drug Interactions

Antiretroviral therapy

a) Nucleoside reverse transcriptase inhibitors

1*

1

1

1

2/3*

2*

2/3*

2*

b) Non-nucleoside reverse transcriptase inhibitors

2*

2*

1

2*

2/3*

2*

2/3*

2*

c) Ritonavir-boosted protease inhibitors

3*

3*

1

2*

2/3*

2*

2/3*

2*

Anticonvulsant therapy

a) Certain anticonvulsants
(phenytoin, carbamazepine,
barbiturates, primidone,
topiramate, oxcarbazepine)

3*

3*

1

2*

1

1

b) Lamotrigine

3*

1

1

1

1

1

Antimicrobial therapy

a) Broad spectrum antibiotics

1

1

1

1

1

1

b) Antifungals

1

1

1

1

1

1

c) Antiparasitics

1

1

1

1

1

1

d) Rifampicin or rifabutin therapy

3*

3*

1

2*

1

1

Abbreviations: AIDS = acquired immunodeficiency syndrome; BMI = body mass index; C = continuation of contraceptive method; COC = combined oral contraceptive; Cu-IUD = copper-containing intrauterine device; DVT = deep venous thrombosis; hCG = human chorionic gonadotropin; HIV = human immunodeficiency virus; I = initiation of contraceptive method; LNG-IUD = levonorgestrel-releasing intrauterine device; NA = not applicable; PE = pulmonary embolism; STI = sexually transmitted infection; VTE = venous thromboembolism.

Source: Modified from CDC. Summary chart of U.S. medical eligibility criteria for contraceptive use. Atlanta, GA: CDC; 2012. (Available at http://www.cdc.gov/reproductivehealth/UnintendedPregnancy/USMEC.htm.)

* Please see the complete guidance for a clarification to this classification: www.cdc.gov/reproductivehealth/unintendedpregnancy/USMEC.htm.

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


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