At a glance
This page summarizes the changes from the 2016 U.S. Medical Eligibility Criteria for Contraceptive Use (U.S. MEC) in the updated 2024 U.S. MEC. The U.S. MEC comprises recommendations for health care providers for the use of specific contraceptive methods by persons who have certain characteristics or medical conditions.
Overview
The classification additions, deletions, and modifications from the 2016 U.S. Medical Eligibility Criteria for Contraceptive Use (U.S. MEC) are summarized in this appendix (Box A1) (Tables A1, A2, and A3). For conditions for which classifications changed for one or more contraceptive methods or for which the condition description underwent a substantive modification, the changes or modifications are noted (Tables A1, A2, and A3). Conditions that do not appear in this table remain unchanged from the 2016 U.S. MEC.
Box A1. Categories for classifying intrauterine devices and hormonal contraceptives
U.S. MEC 1
A condition for which there is no restriction for the use of the contraceptive method
U.S. MEC 2
A condition for which the advantages of using the method generally outweigh the theoretical or proven risks
U.S. MEC 3
A condition for which the theoretical or proven risks usually outweigh the advantages of using the method
U.S. MEC 4
A condition that represents an unacceptable health risk if the contraceptive method is used
Abbreviation: U.S. MEC = U.S. Medical Eligibility Criteria for Contraceptive Use.
Hormonal contraceptive methods and intrauterine devices
| Condition | Cu-IUD | LNG-IUD | Implant | DMPA | POP | CHC | Clarification | |||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Breastfeeding | ||||||||||||
| a. <21 days postpartum | — | — | 2 | 2 | 2 | 4 | Breastfeeding provides important health benefits for breastfeeding parent and infant. The U.S. Dietary Guidelines for Americans and American Academy of Pediatrics recommend that infants be exclusively breastfed for about the first 6 months with continued breastfeeding while introducing appropriate complementary foods for 1 year or longer[1] or up to age 2 years or longer.[2] | |||||
| 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 | CHC: For persons with other risk factors for VTE, these risk factors might increase the classification to a category 4. Breastfeeding: Breastfeeding provides important health benefits for breastfeeding parent and infant. The U.S. Dietary Guidelines for Americans and American Academy of Pediatrics recommend that infants be exclusively breastfed for about the first 6 months with continued breastfeeding while introducing appropriate complementary foods for 1 year or longer[1] or up to age 2 years or longer.[2] | |||||
| ii. Without other risk factors for VTE | — | — | 2 | 2 | 2 | 3 | Breastfeeding provides important health benefits for breastfeeding parent and infant. The U.S. Dietary Guidelines for Americans and American Academy of Pediatrics recommend that infants be exclusively breastfed for about the first 6 months with continued breastfeeding while introducing appropriate complementary foods for 1 year or longer [1] or up to age 2 years or longer.[2] | |||||
| 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 | 2* | 1 | 3 | CHC: For persons with other risk factors for VTE, these risk factors might increase the classification to a category 4. Breastfeeding: Breastfeeding provides important health benefits for breastfeeding parent and infant. The U.S. Dietary Guidelines for Americans and American Academy of Pediatrics recommend that infants be exclusively breastfed for about the first 6 months with continued breastfeeding while introducing appropriate complementary foods for 1 year or longer[1] or up to age 2 years or longer.[2] | |||||
| ii. Without other risk factors for VTE | — | — | 1 | 1 | 1 | 2 | Breastfeeding provides important health benefits for breastfeeding parent and infant. The U.S. Dietary Guidelines for Americans and American Academy of Pediatrics recommend that infants be exclusively breastfed for about the first 6 months with continued breastfeeding while introducing appropriate complementary foods for 1 year or longer[1] or up to age 2 years or longer.[2] | |||||
| d. >42 days postpartum | — | — | 1 | 1 | 1 | 2 | Breastfeeding provides important health benefits for breastfeeding parent and infant. The U.S. Dietary Guidelines for Americans and American Academy of Pediatrics recommend that infants be exclusively breastfed for about the first 6 months with continued breastfeeding while introducing appropriate complementary foods for 1 year or longer[1] or up to age 2 years or longer.[2] | |||||
| Postpartum (nonbreastfeeding) | ||||||||||||
| a. <21 days postpartum | — | — | 1 | 2* | 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 | 2* | 1 | 3 | CHC: For persons with other risk factors for VTE, these risk factors might increase the classification to a category 4. | |||||
| ii. Without other risk factors for VTE | — | — | 1 | 1 | 1 | 2 | — | |||||
| c. >42 days postpartum | — | — | 1 | 1 | 1 | 1 | — | |||||
| Postpartum (including cesarean delivery, breastfeeding, or nonbreastfeeding) | ||||||||||||
| a. <10 minutes after delivery of the placenta | 2* | 2* | — | — | — | — | IUD: Postpartum placement of IUDs is safe and does not appear to increase health risks associated with IUD use such as infection. Higher rates of expulsion during the postpartum period should be considered as they relate to effectiveness, along with patient access to interval placement (i.e., not related to pregnancy) when expulsion rates are lower. Breastfeeding: Breastfeeding provides important health benefits for breastfeeding parent and infant. The U.S. Dietary Guidelines for Americans and American Academy of Pediatrics recommend that infants be exclusively breastfed for about the first 6 months with continued breastfeeding while introducing appropriate complementary foods for 1 year or longer[1] or up to age 2 years or longer.[2] | |||||
| b. 10 minutes after delivery of the placenta to <4 weeks | 2 | 2 | — | — | — | — | IUD: Postpartum placement of IUDs is safe and does not appear to increase health risks associated with IUD use such as infection. Higher rates of expulsion during the postpartum period should be considered as they relate to effectiveness, along with patient access to interval placement (i.e., not related to pregnancy) when expulsion rates are lower. Breastfeeding: Breastfeeding provides important health benefits for breastfeeding parent and infant. The U.S. Dietary Guidelines for Americans and American Academy of Pediatrics recommend that infants be exclusively breastfed for about the first 6 months with continued breastfeeding while introducing appropriate complementary foods for 1 year or longer[1] or up to age 2 years or longer.[2] | |||||
| c. ≥4 weeks | 1 | 1 | — | — | — | — | IUD: Postpartum placement of IUDs is safe and does not appear to increase health risks associated with IUD use such as infection. Higher rates of expulsion during the postpartum period should be considered as they relate to effectiveness, along with patient access to interval placement (i.e., not related to pregnancy) when expulsion rates are lower. Breastfeeding: Breastfeeding provides important health benefits for breastfeeding parent and infant. The U.S. Dietary Guidelines for Americans and American Academy of Pediatrics recommend that infants be exclusively breastfed for about the first 6 months with continued breastfeeding while introducing appropriate complementary foods for 1 year or longer[1] or up to age 2 years or longer.[2] | |||||
| d. Postpartum sepsis | 4 | 4 | — | — | — | — | — | |||||
| Postabortion (spontaneous or induced) | ||||||||||||
| a. First trimester abortion | ||||||||||||
| i. Procedural (surgical)* | 1 | 1 | 1 | 1 | 1 | 1 | IUD: IUDs may be placed immediately after abortion completion.
POC: POCs may be started immediately after abortion completion or at time of medication abortion initiation. DMPA: After a first trimester medication abortion that did not include mifepristone, there is no restriction for the use of DMPA (category 1). After a first trimester medication abortion that included mifepristone, there is no restriction for use of DMPA after abortion completion (category 1) and benefits generally outweigh risks with DMPA use immediately at time of medication abortion initiation (category 2). Concurrent administration of DMPA with mifepristone might slightly decrease medication abortion effectiveness and increase risk for ongoing pregnancy. Risk for ongoing pregnancy with concurrent administration of DMPA with mifepristone should be considered along with personal preference and access to follow-up abortion and contraceptive care.* CHC: CHCs may be started immediately after abortion completion or at time of medication abortion initiation. |
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| ii. Medication* | 1 | 1 | 1 | 1/2* | 1 | 1 | ||||||
| iii. Spontaneous abortion with no intervention* | 1 | 1 | 1 | 1 | 1 | 1 | ||||||
| b. Second trimester abortion | ||||||||||||
| i. Procedural (surgical)* | 2 | 2 | 1 | 1 | 1 | 1 | IUD: IUDs may be placed immediately after abortion completion. POC: POCs may be started immediately after abortion completion or at time of medication abortion initiation. CHC: CHCs may be started immediately after abortion completion or at time of medication abortion initiation. |
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| ii. Medication* | 2 | 2 | 1 | 1 | 1 | 1 | ||||||
| iii. Spontaneous abortion with no intervention* | 2 | 2 | 1 | 1 | 1 | 1 | ||||||
| c. Immediate postseptic abortion | 4 | 4 | 1 | 1 | 1 | 1 | POC: POCs may be started immediately after abortion completion or at time of medication abortion initiation.
CHC: CHCs may be started immediately after abortion completion or at time of medication abortion initiation. |
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| Obesity | ||||||||||||
| a. BMI ≥30 kg/m2 | 1 | 1 | 1 | 1 | 1 | 2 | CHC: Risk for thrombosis increases with multiple risk factors, such as obesity, older age (e.g., ≥40 years), diabetes, smoking, family history of thrombosis, and dyslipidemia. When a person has multiple risk factors, any of which alone would increase risk for thrombosis, use of CHCs might increase thrombosis risk to an unacceptable level. However, a simple addition of categories for multiple risk factors is not intended; for example, a combination of two category 2 risk factors might not necessarily warrant a higher category.* | |||||
| b. Menarche to <18 years and BMI ≥30 kg/m2 | 1 | 1 | 1 | 2 | 1 | 2 | CHC: Risk for thrombosis increases with multiple risk factors, such as obesity, older age (e.g., ≥40 years), diabetes, smoking, family history of thrombosis, and dyslipidemia. When a person has multiple risk factors, any of which alone would increase risk for thrombosis, use of CHCs might increase thrombosis risk to an unacceptable level. However, a simple addition of categories for multiple risk factors is not intended; for example, a combination of two category 2 risk factors might not necessarily warrant a higher category.* | |||||
| Surgery | ||||||||||||
| a. Minor surgery without immobilization | 1 | 1 | 1 | 1 | 1 | 1 | — | |||||
| b. Major surgery | ||||||||||||
| i. Without prolonged immobilization | 1 | 1 | 1 | 1 | 1 | 2 | — | |||||
| ii. With prolonged immobilization | 1 | 1* | 1* | 2 | 1* | 4 | — | |||||
| Deep venous thrombosis/Pulmonary embolism This condition is associated with increased risk for adverse health events as a result of pregnancy (Box 3). |
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| a. Current or history of DVT/PE, receiving anticoagulant therapy (therapeutic dose) (e.g., acute DVT/PE or long-term therapeutic dose)* | 2 | 2 | 2 | 2 | 2 | 3* | Cu-IUD: Persons using anticoagulant therapy are at risk for gynecologic complications of therapy, such as heavy or prolonged bleeding. Cu-IUDs might worsen bleeding.*
LNG-IUD: Persons using anticoagulant therapy are at risk for gynecologic complications of therapy, such as heavy or prolonged bleeding. LNG-IUDs can be of benefit in preventing or treating this complication. When a contraceptive method is used as a therapy, rather than solely to prevent pregnancy, the risk/benefit ratio might differ and should be considered on a case-by-case basis.* POC: Persons using anticoagulant therapy are at risk for gynecologic complications of therapy, such as heavy or prolonged bleeding and hemorrhagic ovarian cysts. POCs can be of benefit in preventing or treating these complications; benefits might vary by POC dose and formulation. When a contraceptive method is used as a therapy, rather than solely to prevent pregnancy, the risk/benefit ratio might differ and should be considered on a case-by-case basis.* CHC: Persons using anticoagulant therapy are at risk for gynecologic complications of therapy, such as heavy or prolonged bleeding and hemorrhagic ovarian cysts. CHCs can be of benefit in preventing or treating these complications. When a contraceptive method is used as a therapy, rather than solely to prevent pregnancy, the risk/benefit ratio might differ and should be considered on a case-by-case basis.* CHC: When a patient discontinues therapeutic dose of anticoagulant therapy, careful consideration should be given to transitioning from CHCs to a progestin-only or nonhormonal method, if acceptable to the patient.* |
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| b. History of DVT/PE, receiving anticoagulant therapy (prophylactic dose)* | Cu-IUD: Persons using anticoagulant therapy are at risk for gynecologic complications of therapy, such as heavy or prolonged bleeding. Cu-IUDs might worsen bleeding.*
LNG-IUD: Persons using anticoagulant therapy are at risk for gynecologic complications of therapy, such as heavy or prolonged bleeding. LNG-IUDs can be of benefit in preventing or treating this complication. When a contraceptive method is used as a therapy, rather than solely to prevent pregnancy, the risk/benefit ratio might differ and should be considered on a case-by-case basis.* POC: Persons using anticoagulant therapy are at risk for gynecologic complications of therapy, such as heavy or prolonged bleeding and hemorrhagic ovarian cysts. POCs can be of benefit in preventing or treating these complications; benefits might vary by POC dose and formulation. When a contraceptive method is used as a therapy, rather than solely to prevent pregnancy, the risk/benefit ratio might differ and should be considered on a case-by-case basis.* CHC: Persons using anticoagulant therapy are at risk for gynecologic complications of therapy, such as heavy or prolonged bleeding and hemorrhagic ovarian cysts. CHCs can be of benefit in preventing or treating these complications. When a contraceptive method is used as a therapy, rather than solely to prevent pregnancy, the risk/benefit ratio might differ and should be considered on a case-by-case basis.* |
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| i. Higher risk for recurrent DVT/PE (one or more risk factors)* | 2 | 2 | 2 | 3* | 2 | 4 | ||||||
|
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| ii. Lower risk for recurrent DVT/PE (no risk factors)* | 2 | 2 | 2 | 2 | 2 | 3 | ||||||
| c. History of DVT/PE, not receiving anticoagulant therapy* | ||||||||||||
| i. Higher risk for recurrent DVT/PE (one or more risk factors)* | 1 | 2 | 2 | 3* | 2 | 4 | ||||||
|
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| ii. Lower risk for recurrent DVT/PE (no risk factors)* | 1 | 2 | 2 | 2 | 2 | 3 | ||||||
| d. Family history (first-degree relatives) | 1 | 1 | 1 | 1 | 1 | 2 | ||||||
| Thrombophilia (e.g., factor V Leiden mutation; prothrombin gene mutation; protein S, protein C, and antithrombin deficiencies; or antiphospholipid syndrome) This condition is associated with increased risk for adverse health events as a result of pregnancy (Box 3). | 1 | 2 | 2 | 3* | 2 | 4 | Routine screening in the general population before contraceptive initiation is not recommended. If a person has current or history of DVT/PE, see recommendations for DVT/PE.* Classification of antiphospholipid syndrome includes presence of a clinical feature (e.g., thrombosis or obstetric morbidity) and persistently abnormal antiphospholipid antibody test on two or more occasions at least 12 weeks apart.[3]* |
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| Superficial venous disorders | ||||||||||||
| a. Varicose veins | 1 | 1 | 1 | 1 | 1 | 1 | — | |||||
| b. Superficial venous thrombosis (acute or history) | 1 | 1 | 1 | 2* | 1 | 3 | CHC: Superficial venous thrombosis might be associated with an increased risk for VTE. If a person has risk factors for concurrent DVT (e.g., thrombophilia or cancer) or has current or history of DVT, see recommendations for DVT/PE. Superficial venous thrombosis associated with a peripheral intravenous catheter is less likely to be associated with additional thrombosis and use of CHCs may be considered. | |||||
| Valvular heart disease Complicated valvular heart disease is a condition associated with increased risk for adverse health events as a result of pregnancy (Box 3). |
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| 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 | 2* | 1 | 4 | ||||||
| Peripartum cardiomyopathy This condition is associated with increased risk for adverse health events as a result of pregnancy (Box 3). |
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| a. Normal or mildly impaired cardiac function (New York Heart Association Functional Class I or II: no limitation of activities or slight, mild limitation of activity)[4] | ||||||||||||
| i. <6 months | 2 | 2 | 1 | 2* | 1 | 4 | — | |||||
| ii. ≥6 months | 2 | 2 | 1 | 2* | 1 | 3 | ||||||
| b. Moderately or severely impaired cardiac function (New York Heart Association Functional Class III or IV: marked limitation of activity or should be at complete rest)[4] | 2 | 2 | 2 | 3* | 2 | 4 | ||||||
| Chronic kidney disease* This condition is associated with increased risk for adverse health events as a result of pregnancy (Box 3). |
Initiation | Continuation | Initiation | Continuation | — | |||||||
| a. Current nephrotic syndrome* | 1* | 1* | 2* | 2* | 2* | 3* | 2* DRSP POP with known hyperkalemia: 4* |
4* | DRSP POP: Persons with known hyperkalemia should not use DRSP POPs because of the risk for worsening hyperkalemia (category 4). For persons with CKD without known hyperkalemia (category 2), consider checking serum potassium level during first cycle of DRSP POPs.* | |||
| b. Hemodialysis* | 1* | 1* | 2* | 2* | 2* | 3* | 2* DRSP POP with known hyperkalemia: 4* |
4* | DRSP POP: Persons with known hyperkalemia should not use DRSP POPs because of the risk for worsening hyperkalemia (category 4). For persons with CKD without known hyperkalemia (category 2), consider checking serum potassium level during first cycle of DRSP POPs.* | |||
| c. Peritoneal dialysis* | 2* | 1* | 2* | 2* | 2* | 3* | 2* DRSP POP with known hyperkalemia: 4* |
4* | DRSP POP: Persons with known hyperkalemia should not use DRSP POPs because of the risk for worsening hyperkalemia (category 4). For persons with CKD without known hyperkalemia (category 2), consider checking serum potassium level during first cycle of DRSP POPs.* | |||
| Systemic lupus erythematosus This condition is associated with increased risk for adverse health events as a result of pregnancy (Box 3). |
Initiation | Continuation | — | Initiation | Continuation | — | ||||||
| a. Positive (or unknown) antiphospholipid antibodies | 1 | 1 | 2* | 2* | 3 | 3 | 2* | 4 | Persons with SLE are at increased risk for ischemic heart disease, stroke, and VTE. Categories assigned to such conditions in U.S. MEC should be the same for persons with SLE who have these conditions. For all subconditions of SLE, classifications are based on the assumption that no other risk factors for cardiovascular disease are present; these classifications must be modified in the presence of such risk factors. | |||
| b. Severe thrombocytopenia | 3 | 2 | 2 | 2 | 3 | 2 | 2 | 2 | Persons with SLE are at increased risk for ischemic heart disease, stroke, and VTE. Categories assigned to such conditions in U.S. MEC should be the same for persons with SLE who have these conditions. For all subconditions of SLE, classifications are based on the assumption that no other risk factors for cardiovascular disease are present; these classifications must be modified in the presence of such risk factors. Severe thrombocytopenia increases the risk for bleeding. The category should be assessed according to the severity of thrombocytopenia and its clinical manifestations. In persons with very severe thrombocytopenia who are at risk for spontaneous bleeding, consultation with a specialist and certain pretreatments might be warranted. | |||
| c. Immunosuppressive therapy | 2 | 1 | 2 | 2 | 2 | 2 | 2 | 2 | Persons with SLE are at increased risk for ischemic heart disease, stroke, and VTE. Categories assigned to such conditions in U.S. MEC should be the same for persons with SLE who have these conditions. For all subconditions of SLE, classifications are based on the assumption that no other risk factors for cardiovascular disease are present; these classifications must be modified in the presence of such risk factors. | |||
| d. None of the above | 1 | 1 | 2 | 2 | 2 | 2 | 2 | 2 | Persons with SLE are at increased risk for ischemic heart disease, stroke, and VTE. Categories assigned to such conditions in U.S. MEC should be the same for persons with SLE who have these conditions. For all subconditions of SLE, classifications are based on the assumption that no other risk factors for cardiovascular disease are present; these classifications must be modified in the presence of such risk factors. | |||
| High risk for HIV infection | Initiation | Continuation | Initiation | Continuation | IUD: Many persons at high risk for HIV infection are also at risk for other STIs (see recommendations for Sexually transmitted infections in U.S. MEC and recommendations on STI screening before IUD placement in U.S. SPR [https://www.cdc.gov/contraception/hcp/usspr]).[5]* | |||||||
| 1* | 1* | 1* | 1* | 1 | 1 | 1 | 1 | |||||
| Cirrhosis Decompensated cirrhosis is associated with increased risk for adverse health events as a result of pregnancy (Box 3). |
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| a. Compensated (normal liver function) | 1 | 1 | 1 | 1 | 1 | 1 | — | |||||
| b. Decompensated (impaired liver function) | 1 | 2* | 2* | 3 | 2* | 4 | ||||||
| Liver tumors Hepatocelluar adenoma and malignant liver tumors are associated with increased risk for adverse health events as a result of pregnancy (Box 3). |
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| a. Benign | ||||||||||||
| i. Focal nodular hyperplasia | 1 | 2 | 2 | 2 | 2 | 2 | ||||||
| ii. Hepatoceullular adenoma | 1 | 2* | 2* | 3 | 2* | 4 | ||||||
| b. Malignant (hepatocellular carcinoma) | 1 | 3 | 3 | 3 | 3 | 4 | ||||||
| Sickle cell disease This condition is associated with increased risk for adverse health events as a result of pregnancy (Box 3). | 2 | 1 | 1 | 2/3* | 1 | 4* | DMPA: The category should be assessed according to the severity of the condition and risk for thrombosis.* | |||||
| Solid organ transplantation This condition is associated with increased risk for adverse health events as a result of pregnancy (Box 3). | Initiation | Continuation | Initiation | Continuation | — | |||||||
| a. No graft failure | 1* | 1* | 1* | 1* | 2 | 2/3* | 2 | 2 | DMPA: DMPA use among persons receiving long-term immunosuppressive therapy with a history of, or risk factors for, nontraumatic fractures is classified as category 3. Otherwise, DMPA use for persons with solid organ transplantation is classified as category 2.* CHC: Persons with transplant due to Budd-Chiari syndrome should not use CHCs because of the increased risk for thrombosis.* | |||
| b. Graft failure | 2* | 1* | 2* | 1* | 2 | 2/3* | 2 | 4 | DMPA: DMPA use among persons receiving long-term immunosuppressive therapy with a history of, or risk factors for, nontraumatic fractures is classified as category 3. Otherwise, DMPA use for persons with solid organ transplantation is classified as category 2.* | |||
| Antiretrovirals used for prevention (PrEP) or treatment of HIV infection*,† | ||||||||||||
| See the following guidelines for the most up-to-date recommendations on drug-drug interactions between hormonal contraception and antiretrovirals: 1) Recommendations for the Use of Antiretroviral Drugs During Pregnancy and Interventions to Reduce Perinatal HIV Transmission in the United States (https://clinicalinfo.hiv.gov/en/guidelines/perinatal/prepregnancy-counseling-childbearing-age-overview?view=full#table-3)[6] and 2) Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents With HIV (https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-arv/drug-interactions-overview?view=full).[7] | ||||||||||||
Abbreviations: ARV = antiretroviral; BMI = body mass index; CHC = combined hormonal contraceptive; CKD = chronic kidney disease; Cu-IUD = copper intrauterine device; DMPA = depot medroxyprogesterone acetate; DRSP = drospirenone; DVT = deep venous thrombosis; IUD = intrauterine device; LNG-IUD = levonorgestrel intrauterine device; PE = pulmonary embolism; POC = progestin-only contraceptive; POP = progestin-only pill; PrEP = pre-exposure prophylaxis; SLE = systemic lupus erythematous; STI = sexually transmitted infection; U.S. MEC = U.S. Medical Eligibility Criteria for Contraceptive Use; U.S. SPR = U.S. Selected Practice Recommendations for Contraceptive Use; VTE = venous thromboembolism.
* Indicates a condition for which the classification changed for one or more contraceptive methods or for which the condition description underwent a substantive modification.
† U.S. MEC recommendations for concurrent use of hormonal contraceptives or IUDs and ARVs for treatment of HIV infection also apply to use of ARVs for PrEP.
Barrier Methods
| Condition | Condom | Spermicide/Vaginal pH modulator*,† | Diaphragm/Cap (with spermicide) | Clarification |
|---|---|---|---|---|
| Chronic kidney disease* This condition is associated with increased risk for adverse health events as a result of pregnancy (Box 3). |
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| a. Current nephrotic syndrome* | 1* | 1* | 1* | — |
| b. Hemodialysis* | 1* | 1* | 1* | — |
| c. Peritoneal dialysis* | 1* | 1* | 1* | — |
| Cervical cancer (awaiting treatment) | 1 | Vaginal pH modulator: 1* Spermicide: 2 |
1 | The cap should not be used. Diaphragm use has no restrictions. |
| High risk for HIV infection | 1 | Vaginal pH modulator: 1* Spermicide: 4 |
4 | — |
| HIV infection For persons 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 (Box 3). |
1 | Vaginal pH modulator: 1* Spermicide: 3 |
3 | |
| Antiretrovirals used for prevention (PrEP) or treatment of HIV infection*,§ | 1 | 1/3/4* | 3/4 | No drug interaction between ARV therapy and barrier method use is known. HIV infection is classified as category 1 for vaginal pH modulator and category 3 for spermicide and diaphragm or cap (see recommendations for HIV infection). High risk for HIV infection is classified as category 1 for vaginal pH modulator and category 4 for spermicide and diaphragm or cap (see recommendations for High risk for HIV infection).* |
Abbreviations: ARV = antiretroviral; PrEP = pre-exposure prophylaxis.
* Indicates a condition for which the classification changed for one or more contraceptive methods or for which the condition description underwent a substantive modification.
† The contraceptive method “Spermicide” has been changed to “Spermicide/Vaginal pH modulator.” Recommendations for “Spermicide/Vaginal pH modulator” are the same as those previously for “Spermicide,” with exceptions noted.
§ U.S. Medical Eligibility Criteria for Contraceptive Use recommendations for concurrent use of barrier methods and ARVs for treatment of HIV infection also apply to use of ARVs for PrEP.
Emergency Contraception
| Condition | Category | Clarification | |||
|---|---|---|---|---|---|
| Cu-IUD | UPA | LNG | COC | ||
| Solid organ transplantation This condition is associated with increased risk for adverse health events as a result of pregnancy (Box 3). |
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| a. No graft failure | 1* | 1 | 1 | 1 | — |
| b. Graft failure | 2* | 1 | 1 | 1 | — |
Abbreviations: COC = combined oral contraceptive; Cu-IUD = copper intrauterine device; LNG = levonorgestrel; UPA = ulipristal acetate.
* Indicates a condition for which the classification changed for one or more contraceptive methods or for which the condition description underwent a substantive modification.
References
- US Department of Agriculture; US Department of Health and Human Services. Dietary guidelines for Americans, 2020–2025. 9th ed. Washington, DC: US Department of Agriculture and US Department of Health and Human Services; 2020. https://www.dietaryguidelines.gov/sites/default/files/2021-03/Dietary_Guidelines_for_Americans-2020-2025.pdf
- Meek JY, Noble L; Section on Breastfeeding. Policy statement: breastfeeding and the use of human milk. Pediatrics 2022;150:e2022057988. PMID:35921640 https://doi.org/10.1542/peds.2022-057988
- Barbhaiya M, Zuily S, Naden R, et al.; ACR/EULAR APS Classification Criteria Collaborators. The 2023 ACR/EULAR Antiphospholipid Syndrome Classification Criteria. Arthritis Rheumatol 2023;75:1687–702. PMID:37635643 https://doi.org/10.1002/art.42624
- The Criteria Committee of the New York Heart Association. Nomenclature and criteria for diagnosis of diseases of the heart and great vessels. 9th ed. Boston, MA: Little, Brown and Co; 1994.
- Curtis KM, Nguyen AT, Tepper NK, et al. U.S. selected practice recommendations for contraceptive use, 2024. MMWR Recomm Rep 2024;73(No. RR-3):1–77.
- Panel on Treatment of HIV During Pregnancy and Prevention of Perinatal Transmission. Recommendations for the use of antiretroviral drugs during pregnancy and interventions to reduce perinatal HIV transmission in the United States. Washington, DC: US Department of Health and Human Services; 2023. https://clinicalinfo.hiv.gov/en/guidelines/perinatal/recommendations-arv-drugs-pregnancy-overview
- Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in adults and adolescents with HIV. Washington, DC: US Department of Health and Human Services; 2023. Washington, DC: US Department of Health and Human Services; 2023. https://clinicalinfo.hiv.gov/sites/default/files/guidelines/documents/adult-adolescent-arv/guidelines-adult-adolescent-arv.pdf