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

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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
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

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

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
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 2 2 2 2 1 2* 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
Antiretroviral therapy Initiation Continuation Initiation Continuation
a. Nucleoside reverse transcriptase inhibitors (NRTIs)
i. Abacavir (ABC) 1/2* 1* 1/2* 1* 1 1 1 1
ii. Tenofovir (TDF) 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. Emtricitabine (FTC) 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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