Medical Eligibility for Initiating Contraception: Absolute and Relative Contraindications

Risk Level 1 2 3 4 Method can be used without restriction Advantages generally outweigh theoretical or proven risks Method not usually recommended unless other, more appropriate methods are not available or not acceptable Method not to be used These contraceptive methods do not protect against sexually transmitted infections (STIs). Condoms should be used to protect against STIs. For more information, see www.who.int/reproductive-health/publications/mec/mec.pdf and http://www.cdc.gov/mmwr/preview/mmwrhtml/rr59e0528a1.htm?s_ cid=rr59e0528a1_e

Condition

Qualifier for condition

Estrogen/ progestin: pill, patch, ring 1 2 1 1 Pill: 3 Patch or ring: 1 1 4 3 2 1 2 2 1 1

Progestinonly: pill 1 1 1 1 3 1 4 3 2 1 1 1 1 1 1 2 2 1 2 3

Progestinonly: injection 1 1 1 1 1 1 4 3 2 1 2 2 1 1 1 2 3 1 1 1

Progestinonly: implant 1 1 1 1 1 1 4 3 2 1 2 2 1 1 1 2 2 1 2 2

Progestin IUD 1 1 1 1 1 1 4 3 2 1 2 4 1 1 1 2 2 2 if well/3 if ill 2 if well/3 if ill 2 if well/3 if ill

Copper IUD 2 2 2 1 1 1 1 1 1 1 1 4 1 1 1 1 1 2 if well/3 if ill 2 if well/3 if ill 2 if well/3 if ill

Anemia

Thalassemia Sickle cell disease Iron-deficiency anemia

Bariatric surgery

Stomach restrictive procedures, including lap band Malabsorptive procedures, including gastric bypass

Breast cancer

Family history of cancer Current In past, no evidence of disease for > 5 years

Breast problems, Undiagnosed mass benign Benign breast disease Cervical cancer and pre-cancerous changes Cervical ectropion Depression Diabetes mellitus (DM) Gestational DM in past DM without vascular disease DM with end-organ damage or > 20 years duration Drug interactions NRTI antiretrovirals NNRTI antiretrovirals Protease inhibitors Anticonvulsants: phenytoin, carbamazepine, barbiturates, primidone, topiramate, oxcarbazepine Cervical intraepithelial neoplasia Cancer, awaiting treatment

1 2 3 1 2 3 3 Must select a pill with 30 mcg of estrogen to maximize efficacy 3 3 1 1 1

Lamotrigine alone (Lamotrigine/valproate combo does not interact with hormones) Rifampin/rifabutin ALL OTHER ANTIBIOTICS & ANTIFUNGALS Endometrial cancer Endometriosis Gallbladder disease Asymptomatic gallstones or s/p cholecystectomy Symptomatic gallstones, without cholecystectomy Pregnancy-related cholestasis in past Hormone-related cholestasis in past Headaches Headaches: migraines Non-migranous Without aura, age < 35 Without aura, age > 35 With aura, any age HIV infection High risk or HIV + AIDS (without drug interactions)

1 3 1 1 1 2 2 1 2 1 1 1 2 1 1 Progestinonly: pill

1 1 1 1 1 2 2 1 2 1 2 2 2 1 1 Progestinonly: injection

1 2 1 1 1 2 2 1 2 1 2 2 2 1 1 Progestinonly: implant

1 1 1 4 1 2 2 1 2 1 2 2 2 2 3 Progestin IUD

1 1 1 4 2 1 1 1 1 1 1 1 1 2 3 Copper IUD

2 3 2 3 1 2 3 4 1 1 Estrogen/ progestin: pill, patch, ring

Condition

Qualifier for condition

over

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Condition

Qualifier for condition

Estrogen/ progestin: pill, patch, ring 2 3 4 2 4 1 4 2 4 4 1 4 2 1 1 1 1 1 3 1

Progestinonly: pill

Progestinonly: injection 1 2 3 2 3 1 3 2 3 3 1 1 1 1 1 1 1 1 1 1

Progestinonly: implant 1 1 2 1 2 1 3 2 3 3 1 1 1 1 1 1 1 1 1 1

Progestin IUD

Copper IUD

Hypertension

During prior pregnancy only now resolved Systolic < 140-159 & diastolic < 90-99 Systolic > 160, diastolic > 100, or with vascular disease

1 1 2 2 2 1 3 2 3 3 1 1 1 1 1 1 1 1 1 1

1 1 2 1 2 1 3 2 3 3 1 1 1 3 1 1 2 4 1 2 2 1

1 1 1 1 1 1 1 1 1 1 1 1 1 3 1 1 2 4 1 1 2 1 See above 1 1 2 4 2 1 2 3 4 1 1 1 1 1 1 1 1 1 3 2 1 1 1 1 1 1 1 1 1 2 Copper IUD

Inflammatory bowel disease Ischemic heart disease Liver Disease

Ulcerative colitis, Crohns disease Past or current Cirrhosismild Cirrhosissevere Tumors-focal nodular hyperplasia Hepatocellular adenoma Tumorsmalignant Viral hepatitis-carrier Viral hepatitisactive

Obesity Ovarian cancer Ovarian cysts Pelvic inflammatory disease Postpartum, not breastfeeding

BMI > 30 kg/meter squared & benign tumors Past, with subsequent pregnancy Past, without subsequent pregnancy Current < 3 weeks postpartum > 3 weeks postpartum

Postpartum IUDs < 10 minutes post-placenta delivery (breastfeeding 10 minutes post-placenta delivery to or not 4 weeks breastfeeding) > 4 weeks Postpartum, & breastfeeding Post-abortion < 1 month postpartum > 1 month postpartum First trimester Second trimester Immediately after septic abortion Rheumatoid arthritis Sexually Transmitted Infections On immunosuppressive therapy Not on immunosuppressive therapy Vaginitis Very high risk Current GC/Chlamydia/ Purulent cervicitis Age < 35 Age > 35, < 15 cigarettes/day Age > 35, > 15 cigarettes/day Seizure disorder Stroke Surgery Without drug interactions Past or current Minor Major, without prolonged immobilization Major, with prolonged immobilization Systemic lupus erythematosis Antiphospholipid Ab + Severe thrombocytopenia Immunosuppressive tx None of the above Thyroid disorders Uterine fibroids Valvular heart disease Varicose veins Venous thrombosis Family history (first-degree relatives) Superficial thrombophlebitis Past DVT Current DVT Simple goiter, hyperthyroidism, hypothyroidism IUDs ok unless fibroids block insertion Uncomplicated Complicated 3 2 1 1 1 2 2 1 1 1 2 3 4 1 4 1 2 4 4 2 2 2 1 1 2 4 1 2 2 4 4 Estrogen/ progestin: pill, patch, ring 2 1 1 1 1 1 1 1 1 1 1 1 1 1 2 1 1 2 3 2 2 2 1 1 1 1 1 1 1 2 2 Progestinonly: pill 2 1 1 1 1 2 2 1 1 1 1 1 1 1 3 1 1 2 3 3 2 2 1 1 1 1 1 1 1 2 2 Progestinonly: injection 2 1 1 1 1 1 1 1 1 1 1 1 1 1 2 1 1 2 3 2 2 2 1 1 1 1 1 1 1 2 2 Progestinonly: implant

See above 1 1 2 4 2 1 2 3 4 1 1 1 1 2 1 1 2 3 2 2 2 1 1 1 1 1 1 1 2 2 Progestin IUD

Smoking

Condition

Qualifier for condition

April 2011

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