TABLE A1. Summary of classifications for hormonal contraceptive methods and intrauterine devices

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Summary of classifications for hormonal contraceptive methods and intrauterine devices
Condition	Cu-IUD		LNG-IUD		Implants		DMPA		POP		CHCs
Personal Characteristics And Reproductive History
Pregnancy	4^*		4^*		NA^*		NA^*		NA^*		NA^*
Age	Menarche to <20 years: 2		Menarche to <20 years: 2		Menarche to <18 years: 1		Menarche to <18 years: 2		Menarche to <18 years: 1		Menarche to <40 years: 1
	≥20 years: 1		≥20 years: 1		18–45 years: 1		18–45 years: 1		18–45 years: 1		≥40 years: 2
					>45 years: 1		>45 years: 2		>45 years: 1
Parity
a. Nulliparous	2		2		1		1		1		1
b. Parous	1		1		1		1		1		1
Breastfeeding
a. <21 days postpartum					2^*		2^*		2^*		4^*
b. 21 to <30 days postpartum
i. With other risk factors for VTE (e.g., age ≥35 years, previous VTE, thrombophilia, immobility, transfusion at delivery, peripartum cardiomyopathy, BMI ≥30 kg/m², postpartum hemorrhage, postcesarean delivery, preeclampsia, or smoking)					2^*		2^*		2^*		3^*
ii. Without other risk factors for VTE					2^*		2^*		2^*		3^*
c. 30–42 days postpartum
i. With other risk factors for VTE (e.g., age ≥35 years, previous VTE, thrombophilia, immobility, transfusion at delivery, peripartum cardiomyopathy, BMI ≥30 kg/m², postpartum hemorrhage, postcesarean delivery, preeclampsia, or smoking)					1^*		1^*		1^*		3^*
ii. Without other risk factors for VTE					1^*		1^*		1^*		2^*
d. >42 days postpartum					1^*		1^*		1^*		2^*
Postpartum (nonbreastfeeding women)
a. <21 days postpartum					1		1		1		4
b. 21–42 days postpartum
i. With other risk factors for VTE (e.g., age ≥35 years, previous VTE, thrombophilia, immobility, transfusion at delivery, peripartum cardiomyopathy, BMI ≥30 kg/m², postpartum hemorrhage, postcesarean delivery, preeclampsia, or smoking)					1		1		1		3^*
ii. Without other risk factors for VTE					1		1		1		2
c. >42 days postpartum					1		1		1		1
Postpartum (including cesarean delivery)
a. <10 minutes after delivery of the placenta
i. Breastfeeding	1^*		2^*
ii. Nonbreastfeeding	1^*		1^*
b. 10 minutes after delivery of the placenta to <4 weeks (breastfeeding or nonbreastfeeding)	2^*		2^*
c. ≥4 weeks (breastfeeding or nonbreastfeeding)	1^*		1^*
d. Postpartum sepsis	4		4
Postabortion
a. First trimester	1^*		1^*		1^*		1^*		1^*		1^*
b. Second trimester	2^*		2^*		1^*		1^*		1^*		1^*
c. Immediate postseptic abortion	4		4		1^*		1^*		1^*		1^*
Past ectopic pregnancy	1		1		1		1		2		1
History of pelvic surgery (see Postpartum [Including Cesarean Delivery] section)	1		1		1		1		1		1
Smoking
a. Age <35 years	1		1		1		1		1		2
b. Age ≥35 years
i. <15 cigarettes/day	1		1		1		1		1		3
ii. ≥15 cigarettes/day	1		1		1		1		1		4
Obesity
a. BMI ≥30 kg/m²	1		1		1		1		1		2
b. Menarche to <18 years and BMI ≥30 kg/m²	1		1		1		2		1		2
History of bariatric surgery This condition is associated with increased risk for adverse health events as a result of pregnancy.
a. Restrictive procedures: decrease storage capacity of the stomach (vertical banded gastroplasty, laparoscopic adjustable gastric band, or laparoscopic sleeve gastrectomy)	1		1		1		1		1		1
b. Malabsorptive procedures: decrease absorption of nutrients and calories by shortening the functional length of the small intestine (Roux-en-Y gastric bypass or biliopancreatic diversion)	1		1		1		1		3		COCs: 3
	1		1		1		1		3		Patch and ring: 1
Cardiovascular Disease
Multiple risk factors for atherosclerotic cardiovascular disease (e.g., older age, smoking, diabetes, hypertension, low HDL, high LDL, or high triglyceride levels)	1		2		2^*		3^*		2^*		3/4^*
Hypertension Systolic blood pressure ≥160 mm Hg or diastolic blood pressure ≥100 mm Hg are associated with increased risk for adverse health events as a result of pregnancy.
a. Adequately controlled hypertension	1^*		1^*		1^*		2^*		1^*		3^*
b. Elevated blood pressure levels (properly taken measurements)
i. Systolic 140–159 mm Hg or diastolic 90–99 mm Hg	1^*		1^*		1^*		2^*		1^*		3^*
ii. Systolic ≥160 mm Hg or diastolic ≥100 mm Hg	1^*		2^*		2^*		3^*		2^*		4^*
c. Vascular disease	1^*		2^*		2^*		3^*		2^*		4^*
History of high blood pressure during pregnancy (when current blood pressure is measurable and normal)	1		1		1		1		1		2
Deep venous thrombosis/ Pulmonary embolism
a. History of DVT/PE, not receiving anticoagulant therapy
i. Higher risk for recurrent DVT/PE (one or more risk factors)	1		2		2		2		2		4
• History of estrogen-associated DVT/PE • Pregnancy-associated DVT/PE • Idiopathic DVT/PE • Known thrombophilia, including antiphospholipid syndrome • Active cancer (metastatic, receiving therapy, or within 6 months after clinical remission), excluding nonmelanoma skin cancer • History of recurrent DVT/PE	1		2		2		2		2		4
ii. Lower risk for recurrent DVT/PE (no risk factors)	1		2		2		2		2		3
b. Acute DVT/PE	2		2		2		2		2		4
c. DVT/PE and established anticoagulant therapy for at least 3 months
i. Higher risk for recurrent DVT/PE (one or more risk factors)	2		2		2		2		2		4^*
• Known thrombophilia, including antiphospholipid syndrome • Active cancer (metastatic, receiving therapy, or within 6 months after clinical remission), excluding nonmelanoma skin cancer • History of recurrent DVT/PE	2		2		2		2		2		4^*
ii. Lower risk for recurrent DVT/PE (no risk factors)	2		2		2		2		2		3^*
d. Family history (first-degree relatives)	1		1		1		1		1		2
e. Major surgery
i. With prolonged immobilization	1		2		2		2		2		4
ii. Without prolonged immobilization	1		1		1		1		1		2
f. Minor surgery without immobilization	1		1		1		1		1		1
Known thrombogenic mutations (e.g., factor V Leiden; prothrombin mutation; and protein S, protein C, and antithrombin deficiencies) This condition is associated with increased risk for adverse health events as a result of pregnancy.	1^*		2^*		2^*		2^*		2^*		4^*
Superficial venous disorders
a. Varicose veins	1		1		1		1		1		1
b. Superficial venous thrombosis (acute or history)	1		1		1		1		1		3^*
Current and history of ischemic heart disease This condition is associated with increased risk for adverse health events as a result of pregnancy.			Initiation	Continuation	Initiation	Continuation			Initiation	Continuation
	1		2	3	2	3	3		2	3	4
Stroke (history of cerebrovascular accident) This condition is associated with increased risk for adverse health events as a result of pregnancy.					Initiation	Continuation			Initiation	Continuation
	1		2		2	3	3		2	3	4
Valvular heart disease Complicated valvular heart disease is associated with increased risk for adverse health events as a result of pregnancy.
a. Uncomplicated	1		1		1		1		1		2
b. Complicated (pulmonary hypertension, risk for atrial fibrillation, or history of subacute bacterial endocarditis)	1		1		1		1		1		4
Peripartum cardiomyopathy This condition is associated with increased risk for adverse health events as a result of pregnancy.
a. Normal or mildly impaired cardiac function (New York Heart Association Functional Class I or II: patients with no limitation of activities or patients with slight, mild limitation of activity) (2)
i. <6 months	2		2		1		1		1		4
ii. ≥6 months	2		2		1		1		1		3
b. Moderately or severely impaired cardiac function (New York Heart Association Functional Class III or IV: patients with marked limitation of activity or patients who should be at complete rest) (2).	2		2		2		2		2		4
Rheumatic Diseases
Systemic lupus erythematosus This condition is associated with increased risk for adverse health events as a result of pregnancy.	Initiation	Continuation					Initiation	Continuation
a. Positive (or unknown) antiphospholipid antibodies	1^*	1^*	3^*		3^*		3^*	3^*	3^*		4^*
b. Severe thrombocytopenia	3^*	2^*	2^*		2^*		3^*	2^*	2^*		2^*
c. Immunosuppressive therapy	2^*	1^*	2^*		2^*		2^*	2^*	2^*		2^*
d. None of the above	1^*	1^*	2^*		2^*		2^*	2^*	2^*		2^*
Rheumatoid arthritis	Initiation	Continuation	Initiation	Continuation
a. Receiving immunosuppressive therapy	2	1	2	1	1		2/3^*		1		2
b. Not receiving immunosuppressive therapy	1		1		1		2		1		2
Neurologic Conditions
Headaches
a. Nonmigraine (mild or severe)	1		1		1		1		1		1^*
b. Migraine
i. Without aura (This category of migraine includes menstrual migraine.)	1		1		1		1		1		2^*
ii. With aura	1		1		1		1		1		4^*
Epilepsy This condition is associated with increased risk for adverse health events as a result of pregnancy.	1		1		1^*		1^*		1^*		1^*
Multiple sclerosis
a. With prolonged immobility	1		1		1		2		1		3
b. Without prolonged immobility	1		1		1		2		1		1
Depressive Disorders
Depressive disorders	1^*		1^*		1^*		1^*		1^*		1^*
Reproductive Tract Infections and Disorders
Vaginal bleeding patterns			Initiation	Continuation
a. Irregular pattern without heavy bleeding	1		1	1	2		2		2		1
b. Heavy or prolonged bleeding (includes regular and irregular patterns)	2^*		1^*	2^*	2^*		2^*		2^*		1^*
Unexplained vaginal bleeding (suspicious for serious condition) before evaluation	Initiation	Continuation	Initiation	Continuation
	4^*	2^*	4^*	2^*	3^*		3^*		2^*		2^*
Endometriosis	2		1		1		1		1		1
Benign ovarian tumors (including cysts)	1		1		1		1		1		1
Severe dysmenorrhea	2		1		1		1		1		1
Gestational trophoblastic disease This condition is associated with increased risk for adverse health events as a result of pregnancy.
a. Suspected gestational trophoblastic disease (immediate postevacuation)
i. Uterine size first trimester	1^*		1^*		1^*		1^*		1^*		1^*
ii. Uterine size second trimester	2^*		2^*		1^*		1^*		1^*		1^*
b. Confirmed gestational trophoblastic disease (after initial evacuation and during monitoring)	Initiation	Continuation	Initiation	Continuation
i. Undetectable/non-pregnant β-hCG levels	1^*	1^*	1^*	1^*	1^*		1^*		1^*		1^*
ii. Decreasing β-hCG levels	2^*	1^*	2^*	1^*	1^*		1^*		1^*		1^*
iii. Persistently elevated β-hCG levels or malignant disease, with no evidence or suspicion of intrauterine disease	2^*	1^*	2^*	1^*	1^*		1^*		1^*		1^*
iv. Persistently elevated β-hCG levels or malignant disease, with evidence or suspicion of intrauterine disease	4^*	2^*	4^*	2^*	1^*		1^*		1^*		1^*
Cervical ectropion	1		1		1		1		1		1
Cervical intraepithelial neoplasia	1		2		2		2		1		2
Cervical cancer (awaiting treatment)	Initiation	Continuation	Initiation	Continuation
Cervical cancer (awaiting treatment)	4	2	4	2	2		2		1		2
Breast disease Breast cancer is associated with increased risk of adverse health events as a result of pregnancy.
a. Undiagnosed mass	1		2		2^*		2^*		2^*		2^*
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	1		4		4		4		4		4
ii. Past and no evidence of current disease for 5 years	1		3		3		3		3		3
Endometrial hyperplasia	1		1		1		1		1		1
Endometrial cancer This condition is associated with increased risk for adverse health events as a result of pregnancy.	Initiation	Continuation	Initiation	Continuation

	4	2	4	2	1		1		1		1
Ovarian cancer This condition is associated with increased risk for adverse health events as a result of pregnancy.	1		1		1		1		1		1
Uterine fibroids	2		2		1		1		1		1
Anatomical abnormalities
a. Distorted uterine cavity (any congenital or acquired uterine abnormality distorting the uterine cavity in a manner that is incompatible with IUD insertion)	4		4
b. Other abnormalities (including cervical stenosis or cervical lacerations) not distorting the uterine cavity or interfering with IUD insertion	2		2
Pelvic inflammatory disease
a. Past PID	Initiation	Continuation	Initiation	Continuation
i. With subsequent pregnancy	1	1	1	1	1		1		1		1
ii. Without subsequent pregnancy	2	2	2	2	1		1		1		1
b. Current PID	4	2^*	4	2^*	1		1		1		1
Sexually transmitted diseases	Initiation	Continuation	Initiation	Continuation
a. Current purulent cervicitis or chlamydial infection or gonococcal infection	4	2^*	4	2^*	1		1		1		1
b. Vaginitis (including Trichomonas vaginalis and bacterial vaginosis)	2	2	2	2	1		1		1		1
c. Other factors related to STDs	2^*	2	2^*	2	1		1		1		1
HIV
	Initiation	Continuation	Initiation	Continuation
High risk for HIV	1^*	1^*	1^*	1^*	1		1		1		1
HIV infection For women with HIV infection who are not clinically well or not receiving ARV therapy, this condition is associated with increased risk for adverse health events as a result of pregnancy.	—	—	—	—	1^*		1^*		1^*		1^*
a. Clinically well receiving ARV therapy	1	1	1	1
b. Not clinically well or not receiving ARV therapy	2	1	2	1
Other Infections
Schistosomiasis Schistosomiasis with fibrosis of the liver is associated with increased risk for adverse health events as a result of pregnancy.
a. Uncomplicated	1		1		1		1		1		1
b. Fibrosis of the liver (if severe, see Cirrhosis)	1		1		1		1		1		1
Tuberculosis This condition is associated with increased risk for adverse health events as a result of pregnancy.	Initiation	Continuation	Initiation	Continuation
a. Nonpelvic	1	1	1	1	1^*		1^*		1^*		1^*
b. Pelvic	4	3	4	3	1^*		1^*		1^*		1^*
Malaria	1		1		1		1		1		1
Endocrine Conditions
Diabetes Insulin-dependent diabetes; diabetes with nephropathy, retinopathy, or neuropathy; diabetes with other vascular disease; or diabetes of >20 years’ duration are associated with increased risk of adverse health events as a result of pregnancy.
a. History of gestational disease	1		1		1		1		1		1
b. Nonvascular disease
i. Non-insulin dependent	1		2		2		2		2		2
ii. Insulin dependent	1		2		2		2		2		2
c. Nephropathy/retinopathy/neuropathy	1		2		2		3		2		3/4^*
d. Other vascular disease or diabetes of >20 years’ duration	1		2		2		3		2		3/4^*
Thyroid disorders
a. Simple goiter	1		1		1		1		1		1
b. Hyperthyroid	1		1		1		1		1		1
c. Hypothyroid	1		1		1		1		1		1
Gastrointestinal Conditions
Inflammatory bowel disease (ulcerative colitis or Crohn’s disease)	1		1		1		2		2		2/3^*
Gallbladder disease
a. Symptomatic
i. Treated by cholecystectomy	1		2		2		2		2		2
ii. Medically treated	1		2		2		2		2		3
iii. Current	1		2		2		2		2		3
b. Asymptomatic	1		2		2		2		2		2
History of cholestasis
a. Pregnancy related	1		1		1		1		1		2
b. Past COC related	1		2		2		2		2		3
Viral hepatitis											Initiation	Continuation
a. Acute or flare	1		1		1		1		1		3/4^*	2
b. Carrier	1		1		1		1		1		1	1
c. Chronic	1		1		1		1		1		1	1
Cirrhosis Severe cirrhosis is associated with increased risk for adverse health events as a result of pregnancy.
a. Mild (compensated)	1		1		1		1		1		1
b. Severe (decompensated)	1		3		3		3		3		4
Liver tumors Hepatocellular adenoma and malignant liver tumors are associated with increased risk for adverse health events as a result of pregnancy.
a. Benign
i. Focal nodular hyperplasia	1		2		2		2		2		2
ii. Hepatocellular adenoma	1		3		3		3		3		4
b. Malignant (hepatoma)	1		3		3		3		3		4
Respiratory Conditions
Cystic fibrosis This condition is associated with increased risk for adverse health events as a result of pregnancy.	1^*		1^*		1^*		2^*		1^*		1^*
Anemias
Thalassemia	2		1		1		1		1		1
Sickle cell disease This condition is associated with increased risk for adverse health events as a result of pregnancy.	2		1		1		1		1		2
Iron-deficiency anemia	2		1		1		1		1		1
Solid Organ Transplantation
Solid organ transplantation This condition is associated with increased risk for adverse health events as a result of pregnancy.	Initiation	Continuation	Initiation	Continuation
a. Complicated: graft failure (acute or chronic), rejection, or cardiac allograft vasculopathy	3	2	3	2	2		2		2		4
b. Uncomplicated	2		2		2		2		2		2^*
Drug Interactions
Antiretrovirals used for prevention (PrEP) or treatment of HIV	Initiation	Continuation	Initiation	Continuation
a. Nucleoside reverse transcriptase inhibitors (NRTIs)
i. Tenofovir (TDF) (Used for prevention (PrEP) or treatment)	1/2^*	1^*	1/2^*	1^*	1		1		1		1
ii. Emtricitabine (FTC) (Used for prevention (PrEP) or treatment)	1/2^*	1^*	1/2^*	1^*	1		1		1		1
iii. Zidovudine (AZT)	1/2^*	1^*	1/2^*	1^*	1		1		1		1
iv. Lamivudine (3TC)	1/2^*	1^*	1/2^*	1^*	1		1		1		1
v. Didanosine (DDI)	1/2^*	1^*	1/2^*	1^*	1		1		1		1
vi. Abacavir (ABC)	1/2^*	1^*	1/2^*	1^*	1		1		1		1
vii. Stavudine (D4T)	1/2^*	1^*	1/2^*	1^*	1		1		1		1
b. Nonnucleoside reverse transcriptase inhibitors (NNRTIs)
i. Efavirenz (EFV)	1/2^*	1^*	1/2^*	1^*	2^*		1^*		2^*		2^*
ii. Etravirine (ETR)	1/2^*	1^*	1/2^*	1^*	1		1		1		1
iii. Nevirapine (NVP)	1/2^*	1^*	1/2^*	1^*	1		1		1		1
iv. Rilpivirine (RPV)	1/2^*	1^*	1/2^*	1^*	1		1		1		1
c. Ritonavir-boosted protease inhibitors
i. Ritonavir-boosted atazanavir (ATV/r)	1/2^*	1^*	1/2^*	1^*	2^*		1^*		2^*		2^*
ii. Ritonavir-boosted darunavir (DRV/r)	1/2^*	1^*	1/2^*	1^*	2^*		1^*		2^*		2^*
iii. Ritonavir-boosted fosemprenavir (FPV/r)	1/2^*	1^*	1/2^*	1^*	2^*		1^*		2^*		2^*
iv. Ritonavir-boosted lopinavir (LPV/r)	1/2^*	1^*	1/2^*	1^*	1		1		1		1
v. Ritonavir-boosted saquinavir (SQV/r)	1/2^*	1^*	1/2^*	1^*	2^*		1^*		2^*		2^*
vi. Ritonavir-boosted tipranavir (TPV/r)	1/2^*	1^*	1/2^*	1^*	2^*		1^*		2^*		2^*
d. Protease inhibitors without ritonavir
i. Atazanavir (ATV)	1/2^*	1^*	1/2^*	1^*	1		1		1		2^*
ii. Fosamprenavir (FPV)	1/2^*	1^*	1/2^*	1^*	2^*		2^*		2^*		3^*
iii. Indinavir (IDV)	1/2^*	1^*	1/2^*	1^*	1		1		1		1
iv. Nelfinavir (NFV)	1/2^*	1^*	1/2^*	1^*	2^*		1^*		2^*		2^*
e. CCR5 co-receptor antagonists
i. Maraviroc (MVC)	1/2^*	1^*	1/2^*	1^*	1		1		1		1
f. HIV integrase strand transfer inhibitors
i. Raltegravir (RAL)	1/2^*	1^*	1/2^*	1^*	1		1		1		1
ii. Dolutegravir (DTG)	1/2^*	1^*	1/2^*	1^*	1		1		1		1
iii. Elvitegravir (EVG)	1/2^*	1^*	1/2^*	1^*	1		1		1		1
g. Fusion inhibitors
i. Enfuvirtide	1/2^*	1^*	1/2^*	1^*	1		1		1		1
Anticonvulsant therapy
a. Certain anticonvulsants (phenytoin, carbamazepine, barbiturates, primidone, topiramate, and oxcarbazepine)	1		1		2^*		1^*		3^*		3^*
b. Lamotrigine	1		1		1		1		1		3^*
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. Rifampin or rifabutin therapy	1		1		2^*		1^*		3^*		3^*
Psychotropic medications
a. SSRIs	1		1		1		1		1		1
St. John’s wort	1		1		2		1		2		2

Abbreviations: BMI = body mass index; COC = combined oral contraceptive; Cu-IUD = copper-containing IUD; DMPA = depot medroxyprogesterone acetate; DVT = deep venous thrombosis; hCG = human chorionic gonadotropin; HDL = high-density lipoprotein; HIV = human immunodeficiency virus.; IUD = intrauterine device; LDL = low-density lipoprotein; LNG-IUD = levonorgestrel-releasing IUD; NA = not applicable; PE = pulmonary embolism; PID = pelvic inflammatory disease; POP = progestin-only pill; SSRI = selective serotonin reuptake inhibitor; STD = sexually transmitted disease.

*Consult the respective appendix for each contraceptive method in the 2016 U.S. Medical Eligibility Criteria for Contraceptive Use (1) for clarifications to the numeric categories.

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