Summary Chart of U.S. Medical Eligibility Criteria for Contraceptive Use Pages 1,2 ..................Color coded in the left column to match the corresponding question of the Oregon Hormonal Contraception Self-Screening Tool Questionnaire. Pages 3,4 .............. Arranged alphabetically by disease state
Key: 1 2 3 4
No restriction (method can be used) Advantages generally outweigh theoretical or proven risks Theoretical or proven risks usually outweigh the advantages Unacceptable health risk (method not to be used)
Updated November 2016. This summary sheet only contains a subset of the recommendations from the US MEC. For complete guidance, see: http://www.cdc.gov/reproductivehealth/unintendedpregnancy/USMEC.htm
Corresponding to the order of the Colorado Hormonal Contraception Self Screening Tool Questionnaire: Condition
Sub-condition
Initiating Continuing Menarche to <40=1 >40=2
Age
Smoking
Pregnancy Postpartum (see also Breastfeeding)
Breastfeeding (see also Postpartum) Diabetes mellitus (DM)
Headaches
Hypertension
History of high blood pressure during pregnancy Hyperlipidemias Peripartum cardiomyopathy‡
Combined pill, patch, ring
a) Age < 35 b) Age > 35, < 15 cigarettes/day c) Age > 35, >15 cigarettes/day (Not Eligible for contraception) a) < 21 days b) 21 days to 42 days: (i) with other risk factors for VTE (ii) without other risk factors for VTE c) > 42 days a) < 1 month postpartum b) 1 month or more postpartum a) History of gestational DM only b) Non-vascular disease b) Other abnormalities: (i) non-insulin dependent (ii) insulin dependent‡ c) Nephropathy/ retinopathy/ neuropathy‡ d) Other vascular disease or diabetes of >20 years' duration‡ a) Non-migrainous b) Migraine: i) without aura, age <35 ii) without aura, age >35 iii) with aura, any age a) Adequately controlled hypertension b) Elevated blood pressure levels (properly taken measurements): (i) systolic 140-159 or diastolic 90-99 (ii) systolic ≥160 or diastolic ≥100‡ c) Vascular disease
a) Normal or mildly impaired cardiac function: (i) < 6 months (ii) > 6 months
Progestin-only pill
Other Contraception Options Indicated for Patient
2 3 4 NA* 4
3* 2
1 1
1 3* 2*
1 2* 1*
Yes Yes Yes
1
1
Yes
Yes Yes Yes Yes Yes Yes NA* Yes Yes Yes
2 2 3/4*
2 2 2
Yes Yes Yes
3/4*
2
Yes
1*
2*
1*
1*
Yes
2* 3* 4*
3* 4* 4*
1* 1* 2*
2* 2* 3* 1*
Yes Yes Yes Yes
3
1
Yes
4
2
Yes
4 2
2 1
Yes Yes
2/3*
2*
Yes
4 3
1 1
Sub-condition
Combined pill, patch, ring Initiating
Initiating Continuing Menarche to <18=1 18-45=1 >45=1 1 1 1 NA* 1
3*
Condition
Yes Yes
b) Moderately or severely impaired cardiac function Multiple risk (such as older age, smoking, factors for arterial diabetes and hypertension) cardiovascular disease Ischemic heart Current and history of disease‡ Valvular heart a) Uncomplicated disease b) Complicated‡ Stroke‡ History of cerebrovascular accident Thrombogenic mutations‡ Deep venous a) History of DVT/PE, not on thrombosis anticoagulant therapy (DVT) /Pulmonary i) higher risk for recurrent embolism (PE) DVT/PE ii) lower risk for recurrent DVT/PE b) Acute DVT/PE c) DVT/PE and established on anticoagulant therapy for at least 3 months i) higher risk for recurrent DVT/PE ii) lower risk for recurrent DVT/PE d) Family history (first-degree relatives) e) Major surgery (i) with prolonged immobilization (ii) without prolonged immobilization f) Minor surgery without immobilization History of a) Restrictive procedures bariatric surgery‡ b) Malabsorptive procedures Breast disease/ Breast Cancer
a) Undiagnosed mass b) Benign breast disease c) Family history of cancer d) Breast cancer:‡ i) current ii) past and no evidence of current disease for 5 years
Continuing
Progestin-only pill
Initiating
Other Contraception Options Indicated for Patient
Continuing
4
2
Yes
3/4*
2*
Yes
4 2 4 4
2
3
Yes
3
Yes Yes Yes
1 1 2
4*
2*
Yes
4
2
Yes
3
2
Yes
4
2
Yes
4*
2
Yes
3*
2
Yes
2
1
Yes
4
2
Yes
2
1
Yes
1
1
Yes
1
1
Yes
COCs: 3
3
Yes
2* 1 1
2* 1 1
Yes Yes Yes
4
4
Yes
3
3
Yes
Condition
Viral hepatitis Cirrhosis Liver tumors
Gallbladder disease
History of Cholestasis Systemic lupus erythematosus‡
Rheumatoid arthritis
Sub-condition
Combined pill, patch, ring Initiating 3/4* 1
Continuing 2 1
Progestin-only pill
Initiating
Other Contraception Options Indicated for Patient
Continuing
1 4
1 1 1 3
Yes Yes Yes Yes
2 4 4
2 3 3
Yes Yes Yes
2 3 3 2 2 3 4
2 2 2 2 1 2 3
Yes Yes Yes Yes Yes Yes Yes
2 2 2 2 2
2 2 2 1 1
Yes Yes Yes Yes Yes
(see also Drug Interactions) a) Non-pelvic b) Pelvic
1* 1* 1*
1* 1* 1*
Yes Yes Yes
High risk HIV infected (see also Drug Interactions)‡ AIDS (see also Drug Interactions) ‡ Clinically well on therapy a) Nucleoside reverse transcriptase inhibitors b) Non-nucleoside reverse transcriptase inhibitors c) Ritonavir-boosted protease inhibitors a) Certain anticonvulsants (phenytoin, carbamazepine, barbiturates, primidone, topiramate, oxcarbazepine) b) Lamotrigine a) Broad spectrum antibiotics b) Antifungals c) Antiparasitics d) Rifampicin or rifabutin therapy
1 1*
1 1*
Yes Yes
1*
1*
Yes
a) Acute or flare b) Carrier/Chronic a) Mild (compensated) b) Severe‡ (decompensated) a) Benign: i) Focal nodular hyperplasia ii) Hepatocellular adenoma‡ b) Malignant‡ a) Symptomatic: (i) treated by cholecystectomy (ii) medically treated (iii) current b) Asymptomatic a) Pregnancy-related b) Past COC-related a) Positive (or unknown) antiphospholipid antibodies b) Severe thrombocytopenia c) Immunosuppressive treatment d) None of the above a) On immunosuppressive therapy b) Not on immunosuppressive therapy
Blood Conditions?
Epilepsy‡ Tuberculosis‡ (see also Drug Interactions) HIV
Antiretroviral therapy
Anticonvulsant therapy
Antimicrobial therapy
1*
If on treatment, see Drug Interactions. 1
Yes
2*
2*
Yes
3*
3*
Yes
3*
3*
Yes
3* 1 1 1 3*
1 1 1 1 3*
Yes Yes Yes Yes Yes
Alphabetical Listing of USMEC Contraceptive Eligibility By Disease State 2
2
Yes
Combined pill, patch, ring
Progestin-only pill
Other Contraception Options Indicated for Patient
b) Asymptomatic Condition
Sub-condition
Combined pill, patch, ring
Initiating Breast disease/ Breast Cancer
a) Undiagnosed mass b) Benign breast disease c) Family history of cancer d) Breast cancer‡ i) current ii) past and no evidence of current disease for 5 years a) < 1 month postpartum b) 1 month or more postpartum
Breastfeeding (see also Postpartum) Cervical cancer Awaiting treatment Cervical ectropion Cervical intraepithelial neoplasia Cirrhosis a) Mild (compensated) b) Severe‡ (decompensated) Cystic Fibrosis Deep venous a) History of DVT/PE, not on thrombosis anticoagulant therapy (DVT) i) higher risk for recurrent /Pulmonary DVT/PE embolism (PE) ii) lower risk for recurrent DVT/PE b) Acute DVT/PE c) DVT/PE and established on anticoagulant therapy for at least 3 months i) higher risk for recurrent DVT/PE ii) lower risk for recurrent DVT/PE d) Family history (first-degree relatives) e) Major surgery (i) with prolonged immobilization (ii) without prolonged immobilization f) Minor surgery without immobilization Depressive disorders Diabetes mellitus a) History of gestational DM only (DM) b) Non-vascular disease Diabetes mellitus (i) non-insulin dependent (cont.) (ii) insulin dependent‡ c) Nephropathy/ retinopathy/ neuropathy‡ d) Other vascular disease or diabetes of >20 years' duration‡ Endometrial cancer‡ Endometrial hyperplasia Endometriosis Epilepsy‡ (see also Drug Interactions) Gallbladder a) Symptomatic disease (i) treated by cholecystectomy (ii) medically treated (iii) current
Continuing
Progestin-only pill
Initiating
Other Contraception Options Indicated for Patient
Sub-condition
Continuing 2*
Yes
1 1
1 1
Yes Yes
Gestational trophoblastic disease
4 3
4 3
Yes Yes
Headaches
3* 2*
2* 1*
Yes Yes
2 1 2
1 1 1
Yes Yes Yes
1 4 1*
1 3 1*
Yes Yes Yes
4
2
Yes
3
2
Yes
4
2
Yes
4*
2
Yes
3*
2
Yes
2
1
Yes
4
2
Yes
2
1
Yes
1
1
Yes
1*
1*
Yes
1
1
Yes
2 2 3/4*
2 2 2
Yes Yes Yes
3/4*
2
Yes
1
1
Yes
1
1
Yes
1 1*
1 1*
Yes Yes
Ovarian cancer‡ Parity
2 3 3
2 2 2
Yes Yes Yes
Past ectopic pregnancy
2*
Initiating
History of bariatric surgery‡
a) Decreasing or undetectable ß-hCG levels b) Persistently elevated ß-hCG levels or malignant disease‡ a) Non-migrainous b) Migraine i) without aura, age <35 ii) without aura, age >35 iii) with aura, any age a) Restrictive procedures b) Malabsorptive procedures
History of a) Pregnancy-related cholestasis b) Past COC-related History of high blood pressure during pregnancy History of pelvic surgery HIV
Hyperlipidemias Hypertension
Inflammatory bowel disease Ischemic heart disease‡ Liver tumors
Malaria Multiple risk factors for arterial cardiovascular disease Obesity
High risk HIV infected (see also Drug Interactions)‡ AIDS (see also Drug Interactions) ‡ Clinically well on therapy a) Adequately controlled hypertension b) Elevated blood pressure levels (properly taken measurements) (i) systolic 140-159 or diastolic 90-99 (ii) systolic ≥160 or diastolic ≥100‡ c) Vascular disease (Ulcerative colitis, Crohn’s disease) Current and history of a) Benign i) Focal nodular hyperplasia ii) Hepatocellular adenoma‡ b) Malignant‡ (such as older age, smoking, diabetes and hypertension)
a) >30 kg/m2 body mass index (BMI) b) Menarche to < 18 years and > 30 kg/m2 BMI a) Nulliparous b) Parous
Continuing
Continuing
Initiating
1
1
Yes
1
1
Yes
1*
2*
1*
1*
Yes
2* 3* 4*
3* 4* 4*
1* 1* 2*
2* 2* 3*
1 COCs: 3 P/R: 1 2 3 2
1 3
Yes Yes Yes Yes Yes
1 2 1
Yes Yes Yes
1
1
Yes
1 1*
1 1*
Yes Yes
1*
1*
Yes
2/3* 3*
If on treatment, see Drug Interactions. 2* 1*
Yes Yes
3
1
Yes
4
2
Yes
4 2/3*
2 2
Yes Yes
4
2
3
Yes
2 4 4 1 3/4*
2 3 3 1 2*
Yes Yes Yes Yes Yes
2
1
Yes
2
1
Yes
1 1 1 1
1 1 1 2
Yes Yes Yes Yes
Alphabetical Listing of USMEC Contraceptive Eligibility By Disease State Condition
Sub-condition
Combined pill, patch, ring Initiating
Pelvic inflammatory disease
a) Past, (assuming no current risk factors of STIs) (i) with subsequent pregnancy (ii) without subsequent pregnancy b) Current Peripartum a) Normal or mildly impaired cardiomyopathy‡ cardiac function (i) < 6 months (ii) > 6 months b) Moderately or severely impaired cardiac function Postabortion a) First trimester b) Second trimester c) Immediately post-septic abortion Postpartum a) < 21 days (see also b) 21 days to 42 days Breastfeeding) (i) with other risk factors for VTE (ii) without other risk factors for VTE c) > 42 days Postpartum (in a) < 10 minutes after delivery of breastfeeding or the placenta non-breastfeeding b) 10 minutes after delivery of the women, including placenta to < 4 weeks post-cesarean c) > 4 weeks section) d) Puerperal sepsis Pregnancy Rheumatoid a) On immunosuppressive arthritis therapy b) Not on immunosuppressive therapy Schistosomiasis a) Uncomplicated b) Fibrosis of the liver‡ Severe dysmenorrhea Sexually a) Current purulent cervicitis or transmitted chlamydial infection or gonorrhea infections (STIs) b) Other STIs (excluding HIV and hepatitis) Sexually c) Vaginitis (including transmitted trichomonas vaginalis and infections bacterial vaginosis) (cont.) d) Increased risk of STIs Smoking a) Age < 35 b) Age > 35, < 15 cigarettes/day c) Age > 35, >15 cigarettes/day Solid organ a) Complicated transplantation‡ b) Uncomplicated Stroke‡ History of cerebrovascular accident Superficial a) Varicose veins venous b) Superficial thrombophlebitis thrombosis Systemic lupus erythematosus‡
Thrombogenic mutations‡
a) Positive (or unknown) antiphospholipid antibodies b) Severe thrombocytopenia c) Immunosuppressive treatment d) None of the above
Continuing
Progestin-only pill Initiating
Other Contraception Options Indicated for Patient
Sub-condition
Continuing
1 1
Yes Yes
1
1
Yes
4 3 4
1 1 2
Yes Yes Yes
1* 1* 1*
1* 1* 1*
Yes Yes Yes
1
Yes
3* 2
1 1
1
1
Yes Yes Yes
NA* 2
NA* 1
NA* Yes
2
1
Yes
1 1 1
1 1 1
Yes Yes Yes
1
1
Yes
1
1
Yes
1
1
Yes
1 2 3 4 4 2* 4
1 1 1 1 2 2
Yes Yes Yes Yes Yes Yes Yes
2
3
Combined pill, patch, ring Initiating
1 1
4
Condition
1 2
1 1
Yes Yes
4
3
Yes
2 2 2 4*
2 2 2 2*
Yes Yes Yes Yes
Thyroid disorders Simple goiter/ hyperthyroid/hypothyroid. Tuberculosis‡ a) Non-pelvic (see also Drug Interactions) b) Pelvic Unexplained (suspicious for serious condition) vaginal bleeding before evaluation Uterine fibroids Valvular heart a) Uncomplicated disease b) Complicated‡ Vaginal a) Irregular pattern without bleeding heavy bleeding patterns b) Heavy or prolonged bleeding Viral hepatitis a) Acute or flare b) Carrier/Chronic Antiretroviral Fosamprenavir (FPV) therapy (All other ARVs are 1 or 2 for all methods) Anticonvulsant a) Certain anticonvulsants therapy (phenytoin, carbamazepine, barbiturates, primidone, topiramate, oxcarbazepine) b) Lamotrigine Antimicrobial a) Broad spectrum antibiotics therapy b) Antifungals c) Antiparasitics d) Rifampicin or rifabutin therapy SSRIs St. John’s Wort
Continuing
Progestin-only pill Initiating
Other Contraception Options Indicated for Patient
Continuing
1
1
Yes
1*
1*
Yes
1* 2*
1* 2*
Yes Yes
1 2
1 1
Yes Yes
4 1
1 2
Yes Yes
2* 1
3*
1 2*
Yes Yes Yes Yes
3*
3*
Yes
3* 1 1 1 3*
1 1 1 1 3*
Yes Yes Yes Yes Yes
1
1
Yes
1* 3/4* 1
2 1
2 2 I = initiation of contraceptive method; C = continuation of contraceptive method; NA = Not applicable * Please see the complete guidance for a clarification to this classification: www.cdc.gov/reproductivehealth/unintendedpregnancy/USMEC.htm ‡ Condition that exposes a woman to increased risk as a result of unintended pregnancy.
Yes
