Appendix C: Examinations and Tests Needed Before Initiation of Contraceptive Methods
The examinations or tests noted apply to women who are presumed to be healthy (Table C1). Those with known medical problems or other special conditions might need additional examinations or tests before being determined to be appropriate candidates for a particular method of contraception.. The 2016 U.S. Medical Eligibility Criteria for Contraceptive Use (U.S. MEC) might be useful in such circumstances (1). The following classification was considered useful in differentiating the applicability of the various examinations or tests:
Class A: essential and mandatory in all circumstances for safe and effective use of the contraceptive method.
Class B: contributes substantially to safe and effective use, but implementation may be considered within the public health and/or service context; risk of not performing an examination or test should be balanced against the benefits of making the contraceptive method available.
Class C: does not contribute substantially to safe and effective use of the contraceptive method.
These classifications focus on the relationship of the examinations or tests to safe initiation of a contraceptive method. They are not intended to address the appropriateness of these examinations or tests in other circumstances. For example, some of the examinations or tests that are not deemed necessary for safe and effective contraceptive use might be appropriate for good preventive health care or for diagnosing or assessing suspected medical conditions. Any additional screening needed for preventative health care can be performed at the time of contraception initiation and initiation should not be delayed for test results.
No examinations or tests are needed before initiating condoms or spermicides. A bimanual examination is necessary for diaphragm fitting. A bimanual examination and cervical inspection are needed for cervical cap fitting.
|Examination or test||Contraceptive method and class|
|Cu-IUD and LNG-IUD||Implant||Injectable||CHC||POP||Condom||Diaphragm or
|Weight (BMI) (weight [kg]/height [m]2)||—†||—†||—†||—†||—†||C||C||C|
|Clinical breast examination||C||C||C||C||C||C||C||C|
|Bimanual examination and cervical inspection||A||C||C||C||C||C||A§||C|
|Cervical cytology (Papanicolaou smear)||C||C||C||C||C||C||C||C|
|STD screening with laboratory tests||—¶||C||C||C||C||C||C||C|
|HIV screening with laboratory tests||C||C||C||C||C||C||C||C|
Abbreviations: BMI = body mass index; CHC = combined hormonal contraceptive; Cu-IUD = copper-containing intrauterine device; HIV = human immunodeficiency virus; LNG-IUD = levonorgestrel-releasing intrauterine device; POP = progestin-only pill; STD = sexually transmitted disease; U.S. MEC = U.S. Medical Eligibility Criteria for Contraceptive Use.
*In instances in which blood pressure cannot be measured by a provider, blood pressure measured in other settings can be reported by the woman to her provider.
† Weight (BMI) measurement is not needed to determine medical eligibility for any methods of contraception because all methods can be used (U.S. MEC 1) or generally can be used (U.S. MEC 2) among obese women (Box 1). However, measuring weight and calculating BMI at baseline might be helpful for monitoring any changes and counseling women who might be concerned about weight change perceived to be associated with their contraceptive method.
§ A bimanual examination (not cervical inspection) is needed for diaphragm fitting.
¶ Most women do not require additional STD screening at the time of IUD insertion. If a woman with risk factors for STDs has not been screened for gonorrhea and chlamydia according to CDC’s STD Treatment Guidelines (available at https://www.cdc.gov/std/treatment), screening can be performed at the time of IUD insertion, and insertion should not be delayed. Women with current purulent cervicitis or chlamydial infection or gonococcal infection should not undergo IUD insertion (U.S. MEC 4).
- Curtis KM, Tepper NK, Jatlaoui TC, et al. U.S. medical eligibility criteria for contraceptive use, 2016. MMWR Recomm Rep 2016;65(No. RR-3).