Appendix K: Summary of Classifications for Hormonal Contraceptive Methods and Intrauterine Devices

At a glance

This page provides a summary of recommendations for health care providers for the use of hormonal contraceptive methods and intrauterine devices for persons who have certain characteristics or medical conditions. This information comes from the 2024 U.S. Medical Eligibility Criteria for Contraceptive Use (U.S. MEC).

Overview

Health care providers can use the summary table as a quick reference guide to the classifications for hormonal contraceptive methods and intrauterine contraception to compare classifications across these methods (Box K1) (Table K1). See the respective appendix for each method for clarifications to the numeric categories, as well as for summaries of the evidence and additional comments. Hormonal contraceptives and intrauterine devices do not protect against sexually transmitted infections (STIs), including HIV infection, and patients using these methods should be counseled that consistent and correct use of external (male) latex condoms reduces the risk for STIs, including HIV infection.[1] Use of internal (female) condoms can provide protection from transmission of STIs, although data are limited.[1] Patients also should be counseled that pre-exposure prophylaxis, when taken as prescribed, is highly effective for preventing HIV infection.[2]

Box K1. Categories for classifying hormonal contraceptives and intrauterine devices

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.

Table K1. Summary of classifications for hormonal contraceptive methods and intrauterine devices

TABLE K1 CONDITIONS

Table K1.Summary of classifications for hormonal contraceptive methods and intrauterine devices
Condition Cu-IUD LNG-IUD Implant DMPA POP CHC
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* 2* 1* 3*
  ii. Without other risk factors for VTE — — 1* 1* 1* 2*
d. >42 days postpartum — — 1* 1* 1* 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*
  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* — — — —
b. 10 minutes after delivery of the placenta to <4 weeks 2* 2* — — — —
c. ≥4 weeks 1* 1* — — — —
d. Postpartum sepsis 4 4 — — — —
Postabortion (spontaneous or induced)
a. First trimester abortion
  i. Procedural (surgical) 1* 1* 1* 1* 1* 1*
  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*
  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*
Past ectopic pregnancy 1 1 1 1 2 1
History of pelvic surgery (see recommendations for Postpartum [including cesarean delivery]) 1 1 1 1 1 1
Smoking
a. Age <35 years 1 1 1 1 1 2
b. Age ≥35 years
  i. <15 cigarettes per day 1 1 1 1 1 3
  ii. ≥15 cigarettes per 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 (Box 3).
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
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

* Consult the appendix for this contraceptive method for a clarification to this classification.

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Table K1.Summary of classifications for hormonal contraceptive methods and intrauterine devices
Condition Cu-IUD LNG-IUD Implant DMPA POP CHC
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 (Box 3).
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
This condition is associated with increased risk
for adverse health events as a result of
pregnancy (Box 3).
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*
b. History of DVT/PE, receiving anticoagulant therapy
(prophylactic dose)
  i. Higher risk for recurrent DVT/PE (one or more risk factors) 2* 2* 2* 3* 2* 4*
• Thrombophilia (e.g., factor V Leiden mutation; prothrombin gene mutation; protein S, protein C, and antithrombin deficiencies; or 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*
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
• History of estrogen-associated DVT/PE
• Pregnancy-associated DVT/PE
• Idiopathic DVT/PE
• Thrombophilia (e.g., factor V Leiden mutation; prothrombin gene mutation; protein S, protein C, and antithrombin deficiencies; or 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
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*
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*
Current and history of ischemic heart disease
This condition is associated with increased risk for adverse health events as a result of pregnancy (Box 3).		 1 Initiation Continuation Initiation Continuation 3 Initiation Continuation 4
2 3 2 3 2 3
Stroke (history of cerebrovascular accident)
This condition is associated with increased risk for adverse health events as a result of pregnancy (Box 3).		 1 2 Initiation Continuation 3 Initiation Continuation 4
2 3 2 3
Valvular heart disease
Complicated valvular heart disease is associated with
increased risk for adverse health events as a result of
pregnancy (Box 3).
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).
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)[3]
  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)[3] 2 2 2 3 2 4

* Consult the appendix for this contraceptive method for a clarification to this classification.

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Table K1.Summary of classifications for hormonal contraceptive methods and intrauterine devices
Condition Cu-IUD LNG-IUD Implant DMPA POP CHC
Renal Disease
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
b. Hemodialysis 1 1 2 2 2 3 2*
DRSP POP with known hyperkalemia: 4*		 4
c. Peritoneal dialysis 2 1 2 2 2 3 2*
DRSP POP with known hyperkalemia: 4*		 4

* Consult the appendix for this contraceptive method for a clarification to this classification.

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Table K1.Summary of classifications for hormonal contraceptive methods and intrauterine devices
Condition Cu-IUD LNG-IUD Implant DMPA POP CHC
Rheumatic Diseases
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*
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. Not receiving immunosuppressive therapy 1 1 1 1 1 2 1 2
b. Receiving immunosuppressive therapy 2 1 2 1 1 2/3* 1 2

* Consult the appendix for this contraceptive method for a clarification to this classification.

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Table K1.Summary of classifications for hormonal contraceptive methods and intrauterine devices
Condition Cu-IUD LNG-IUD Implant DMPA POP CHC
Neurologic Conditions
Headaches
a. Nonmigraine (mild or severe) 1 1 1 1 1 1*
b. Migraine
  i. Without aura (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 (Box 3).		 1 1 1* 1* 1* 1*
Multiple sclerosis
a. Without prolonged immobility 1 1 1 2 1 1
b. With prolonged immobility 1 1 1 2 1 3

* Consult the appendix for this contraceptive method for a clarification to this classification.

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Table K1.Summary of classifications for hormonal contraceptive methods and intrauterine devices
Condition Cu-IUD LNG-IUD Implant DMPA POP CHC
Depressive Disorders
Depressive disorders 1* 1* 1* 1* 1* 1*

* Consult the appendix for this contraceptive method for a clarification to this classification.

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Table K1.Summary of classifications for hormonal contraceptive methods and intrauterine devices
Condition Cu-IUD LNG-IUD Implant DMPA POP CHC
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 (Box 3).
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 or nonpregnant 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 for
adverse health events as a result of pregnancy (Box 3).
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 (Box 3).		 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 (Box 3).		 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 placement) 4 4 —
b. Other abnormalities (including cervical stenosis or cervical lacerations) not distorting the uterine cavity or interfering with IUD placement 2 2
Pelvic inflammatory disease Initiation Continuation Initiation Continuation —
a. Current PID 4 2* 4 2* 1 1 1 1
b. Past PID
  i. With subsequent pregnancy 1 1 1 1 1 1 1 1
  ii. Without subsequent pregnancy 2 2 2 2 1 1 1 1
Sexually transmitted infections 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 STIs 2* 2 2* 2 1 1 1 1

* Consult the appendix for this contraceptive method for a clarification to this classification.

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Table K1.Summary of classifications for hormonal contraceptive methods and intrauterine devices
Condition Cu-IUD LNG-IUD Implant DMPA POP CHC
HIV
High risk for HIV infection Initiation Continuation Initiation Continuation —
1* 1* 1* 1* 1 1 1 1
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* 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 — — — —

* Consult the appendix for this contraceptive method for a clarification to this classification.

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Table K1.Summary of classifications for hormonal contraceptive methods and intrauterine devices
Condition Cu-IUD LNG-IUD Implant DMPA POP CHC
Other Infections
Schistosomiasis
Schistosomiasis with fibrosis of the liver is associated
with increased risk for adverse health events
as a result of pregnancy (Box 3).
a. Uncomplicated 1 1 1 1 1 1
b. Fibrosis of the liver (if severe, see recommendations for Cirrhosis) 1 1 1 1 1 1
Tuberculosis
This condition is associated with increased risk for adverse health events as a result of pregnancy (Box 3).		 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

* Consult the appendix for this contraceptive method for a clarification to this classification.

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Table K1.Summary of classifications for hormonal contraceptive methods and intrauterine devices
Condition Cu-IUD LNG-IUD Implant DMPA POP CHC
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 for adverse health events
as a result of pregnancy (Box 3).
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, or 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

* Consult the appendix for this contraceptive method for a clarification to this classification.

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Table K1.Summary of classifications for hormonal contraceptive methods and intrauterine devices
Condition Cu-IUD LNG-IUD Implant DMPA POP CHC
Gastrointestinal Conditions
Inflammatory bowel disease (ulcerative colitis or Crohn’s disease) 1 1 1 2 2 2/3*
Gallbladder disease
a. Asymptomatic 1 2 2 2 2 2
b. Symptomatic
  i. Current 1 2 2 2 2 3
  ii. Treated by cholecystectomy 1 2 2 2 2 2
  iii. Medically treated 1 2 2 2 2 3
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. Chronic 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).
a. Compensated (normal liver function) 1 1 1 1 1 1
b. Decompensated (impaired liver function) 1 2 2 3 2 4
Liver tumors
Hepatocellular adenoma and malignant liver tumors are
associated with increased risk for adverse health events
as a result of pregnancy (Box 3).
a. Benign
  i. Focal nodular hyperplasia 1 2 2 2 2 2
  ii. Hepatocellular adenoma 1 2 2 3 2 4
b. Malignant (hepatocellular carcinoma) 1 3 3 3 3 4

* Consult the appendix for this contraceptive method for a clarification to this classification.

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Table K1.Summary of classifications for hormonal contraceptive methods and intrauterine devices
Condition Cu-IUD LNG-IUD Implant DMPA POP CHC
Respiratory Conditions
Cystic fibrosis
This condition is associated with increased risk for adverse health events as a result of pregnancy (Box 3).		 1* 1* 1* 2* 1* 1*

* Consult the appendix for this contraceptive method for a clarification to this classification.

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Table K1.Summary of classifications for hormonal contraceptive methods and intrauterine devices
Condition Cu-IUD LNG-IUD Implant DMPA POP CHC
Hematologic Conditions
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 (Box 3).		 2 1 1 2/3* 1 4
Iron-deficiency anemia 2 1 1 1 1 1

* Consult the appendix for this contraceptive method for a clarification to this classification.

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Table K1.Summary of classifications for hormonal contraceptive methods and intrauterine devices
Condition Cu-IUD LNG-IUD Implant DMPA POP CHC
Solid Organ Transplantation
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*
b. Graft failure 2 1 2 1 2 2/3* 2 4

* Consult the appendix for this contraceptive method for a clarification to this classification.

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Table K1.Summary of classifications for hormonal contraceptive methods and intrauterine devices
Condition Cu-IUD LNG-IUD Implant DMPA POP CHC
Drug Interactions
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 (https://clinicalinfo.hiv.gov/en/guidelines/perinatal/prepregnancy-counseling-childbearing-age-overview?view=full#table-3)[4] 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).[5]
a. Nucleoside reverse transcriptase inhibitors (NRTIs) Initiation Continuation Initiation Continuation —
  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 fosamprenavir (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. Selective serotonin reuptake inhibitors (SSRIs) 1 1 1 1 1 1
St. John’s wort 1 1 2 1 2 2

* Consult the appendix for this contraceptive method for a clarification to this classification.

Abbreviations: ARV = antiretroviral; BMI = body mass index; CHC = combined hormonal contraceptive; COC = combined oral contraceptive; Cu-IUD = copper intrauterine device; DMPA = depot medroxyprogesterone acetate; DRSP = drospirenone; DVT = deep venous thrombosis; hCG = human chorionic gonadotropin; HDL = high-density lipoprotein; IUD = intrauterine device; LDL = low-density lipoprotein; LNG-IUD = levonorgestrel intrauterine device; NA = not applicable; PE = pulmonary embolism; PID = pelvic inflammatory disease; POP = progestin-only pill; PrEP = pre-exposure prophylaxis; STI = sexually transmitted infection; VTE = venous thromboembolism.

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References

  1. Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. MMWR Recomm Rep 2021;70(No. RR-4):1–187. PMID:34292926 https://doi.org/10.15585/mmwr.rr7004a1
  2. CDC. US Public Health Service preexposure prophylaxis for the prevention of HIV infection in the United States—2021 update: a clinical practice guideline. Atlanta, GA: US Department of Health and Human Services, CDC; 2021. https://www.cdc.gov/hiv/pdf/risk/prep/cdc-hiv-prep-guidelines-2021.pdf
  3. 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.
  4. 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
  5. 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. https://clinicalinfo.hiv.gov/sites/default/files/guidelines/documents/adult-adolescent-arv/guidelines-adult-adolescent-arv.pdf

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National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP); Division of Reproductive Health