US Selected Practice Recommendations for Contraceptive Use, 2016

Table of Contents

• Summary
• Introduction
  • Summary of Changes from the 2013 U.S. SPR
  • Methods
  • Maintaining Updated Guidance
  • How To Use This Document
  • Contraceptive Method Choice
  • Box 1. Categories of medical eligibility criteria for contraceptive use
  • Figure 1. Effectiveness of family planning methods
• How To Be Reasonably Certain that a Woman Is Not Pregnant
  • Box 2. How To Be Reasonably Certain that a Woman Is Not Pregnant
• Intrauterine Contraception
  • Initiation of Cu-IUDs
    • Timing
    • Need for Back-Up Contraception
    • Amenorrhea (Not Postpartum)
    • Postpartum (Including After Cesarean Section)
    • Postabortion (Spontaneous or Induced)
    • Switching from Another Contraceptive Method
  • Initiation of LNG-IUDs
    • Timing of LNG-IUD Insertion
    • Need for Back-Up Contraception
    • Amenorrhea (Not Postpartum)
    • Postpartum (Including After Cesarean Section)
    • Postabortion (Spontaneous or Induced)
    • Switching from Another Contraceptive Method
  • Examinations and Tests Needed Before Initiation of Cu-IUD or an LNG-IUD
  • Provision of Prophylactic Antibiotics at the Time of IUD Insertion
  • Routine Follow-Up After IUD Insertion
  • Bleeding Irregularities with Cu-IUD Use
  • Bleeding Irregularities (Including Amenorrhea) with LNG-IUD Use
  • Management of the IUD when a Cu-IUD or an LNG-IUD User Is Found To Have PID
  • Management of the IUD when a Cu-IUD or an LNG-IUD User Is Found To Be Pregnant
  • Table 1. Classification of examinations and tests needed before IUD insertion
• Implants
  • Initiation of Implants
    • Timing
    • Need for Back-Up Contraception
    • Amenorrhea (Not Postpartum)
    • Postpartum (Breastfeeding)
    • Postpartum (Not Breastfeeding)
    • Postabortion (Spontaneous or Induced)
    • Switching from Another Contraceptive Method
  • Examinations and Tests Needed Before Implant Insertion
  • Routine Follow-Up After Implant Insertion
  • Bleeding Irregularities (Including Amenorrhea) During Implant Use
  • Table 2. Classification of examinations and tests needed before implant insertion
• Injectables
  • Initiation of Injectables
    • Timing
    • Need for Back-Up Contraception
    • Amenorrhea (Not Postpartum)
    • Postpartum (Breastfeeding)
    • Postpartum (Not Breastfeeding)
    • Postabortion (Spontaneous or Induced)
    • Switching from Another Contraceptive Method
  • Examinations and Tests Needed Before Initiation of an Injectable
  • Routine Follow-Up After Injectable Initiation
  • Timing of Repeat Injections
  • Bleeding Irregularities (Including Amenorrhea) During Injectable Use
  • Table 3. Classification of examinations and tests needed before DMPA initiation
• Combined Hormonal Contraceptives
  • Initiation of CHCs
    • Timing
    • Need for Back-Up Contraception
    • Amenorrhea (Not Postpartum)
    • Postpartum (Breastfeeding)
    • Postpartum (Not Breastfeeding)
    • Postabortion (Spontaneous or Induced)
    • Switching from Another Contraceptive Method
  • Examinations and Tests Needed Before Initiation of CHCs
  • Number of Pill Packs that Should be Provided at Initial and Return Visits
  • Routine Follow-Up After CHCs
  • Late or Missed Doses and Side Effects from CHCs Use
  • Vomiting or Severe Diarrhea While Using COCs
  • Unscheduled Bleeding with Extended or Continuous Use of CHCs
  • Figure 2. Recommended actions after late or missed combined oral contraceptives
  • Figure 3. Recommended actions after delayed application or detachment with combined hormonal patch
  • Figure 4. Recommended actions after delayed insertion or reinsertion with combined vaginal ring
  • Table 4. Classification of examinations and tests needed before combined hormonal contraceptive initiation
  • Figure 5. Recommended steps after vomiting or diarrhea while using combined oral contraceptives
• Progestin-Only Pills
  • Initiation of POPs
    • Timing
    • Need for Back-Up Contraception
    • Amenorrhea (Not Postpartum)
    • Postpartum (Breastfeeding)
    • Postpartum (Not Breastfeeding)
    • Postabortion (Spontaneous or Induced)
    • Switching from Another Contraceptive Method
  • Examinations and Tests Needed Before Initiation of POPs
  • Number of Pill Packs that Should be Provided at Initial and Return Visits
  • Routine Follow-Up After POPs initation
  • Missed POPs
  • Vomiting or Severe Diarrhea (for any reason or duration) that occurs within 3 hours after taking pill
  • Table 5. Classification of examinations and tests needed before POP initiation
• Standard Days Method
  • Use of SDM Among Women with Various Menstrual Cycle Durations
• Emergency Contraception
  • Types of Emergency Contraception
    • Intrauterine Device
    • ECPs
  • Initiation of Emergency Contraception
    • Timing of EC
  • Advance Provision of ECPs
  • Initiation of Regular Contraception After  ECPs
    • UPA
    • Levonorgestrel and Combined Estrogen and Progestion ECPs
  • Prevention and Management of Nausea and Vomiting with ECP Use
    • Nausea and Vomiting
    • Vomiting Within 3 Hours of Taking ECPs
• Female Sterilization
  • When Hysteroscopic Sterilization Is Reliable for Contraception
  • When Laparoscopic and Abdominal Approches Are Reliable for Contraception
• Male Sterilization
  • When Vasectomy Is Reliable for Contraception
  • Other Postprocedure Recommendations
• When Women Can Stop Using Contraceptives
• Conclusion
• References
• Appendix A:Summary Chart of U.S. Medical Eligibility Criteria for Contraceptive Use, 2016
• Appendix B: When To Start Using Specific Contraceptive Methods
• Appendix C: Examinations and Tests Needed Before Initiation of Contraceptive Methods
• Appendix D: Routine Follow-Up After Contraceptive Initiation
• Appendix E: Management of Women with Bleeding Irregularities While Using Contraception
• Appendix F: Management of Intrauterine Devices When Users are Found To Have Pelvic Inflammatory Disease
• Participants