Summary of Changes from the 2016 U.S. SPR

At a glance

This page summarizes the changes from the 2016 U.S. Selected Practice Recommendations for Contraceptive Use (U.S. SPR). The 2024 U.S. SPR provides updated recommendations for health care providers that address a selected group of common, yet sometimes complex, issues regarding initiation and use of specific contraceptive methods.

Updated recommendations

Recommendations for provision of medications for intrauterine device (IUD) placement and management of bleeding irregularities (including amenorrhea) during implant use have been updated from the 2016 U.S. SPR. Substantive modifications from the 2016 U.S. SPR are noted with an asterisk.

Provision of Medications for IUD Placement

  • Misoprostol is not recommended for routine use for IUD placement. Misoprostol might be useful in selected circumstances (e.g., in patients with a recent failed placement).
  • Lidocaine (paracervical block or topical) for IUD placement might be useful for reducing patient pain.*

Bleeding Irregularities (Including Amenorrhea) During Implant Use

  • Before implant placement, provide counseling about potential changes in bleeding patterns during implant use. Spotting or light bleeding is common with implant use, and certain implant users experience amenorrhea. These bleeding changes are generally not harmful but might be bothersome to the patient. Bleeding changes might or might not decrease with continued implant use. Heavy bleeding is uncommon during implant use.

Bleeding Irregularities (Spotting, Light Bleeding, or Heavy or Prolonged Bleeding)

  • If clinically indicated, consider an underlying health condition, such as interactions with other medications, sexually transmitted infections (STIs), pregnancy, thyroid disorders, or new pathologic uterine conditions (e.g., polyps or fibroids). If an underlying health condition is found, treat the condition or refer for care.
  • Explore patient goals, including continued implant use (with or without treatment for bleeding irregularities) or implant removal. If the patient wants to continue implant use, provide reassurance, discuss options for management of bleeding irregularities if it is desired, and advise the patient that they may contact their provider at any time to discuss bleeding irregularities or other side effects.
  • If the patient desires implant removal at any time, remove the implant, offer counseling on alternative contraceptive methods, and initiate another method if it is desired.
  • If the patient wants treatment, the following treatment options may be considered, depending on the patient's preferences, treatment goals, and medical history:*
    • Treatments that might improve bleeding irregularities during treatment use; bleeding is likely to recur after treatment cessation. Treatment may be repeated as needed.*
      • Hormonal treatment (e.g., 20–30 ethinyl estradiol [EE] combined oral contraceptives [COCs] or estrogen).*
      • Hormonal treatment (e.g., 20–30 µg Antifibrinolytic agents (e.g., tranexamic acid), 5 days.*
    • Treatments that might improve bleeding irregularities during treatment use and whose effects might persist for some time after treatment cessation. Treatment may be repeated as needed.*
      • Nonsteroidal anti-inflammatory drugs (NSAIDs) (e.g., celecoxib, ibuprofen, or mefenamic acid), 5–7 days.*
      • Selective estrogen receptor modulators (SERMs) (e.g., tamoxifen), 7–10 days.*

Amenorrhea

  • Amenorrhea does not require any medical treatment. Provide reassurance.
    • If a patient's regular bleeding pattern changes abruptly to amenorrhea, consider ruling out pregnancy if clinically indicated.
    • If the patient desires implant removal, remove the implant, offer counseling on alternative contraceptive methods, and initiate another method if it is desired.

New recommendations

Recommendations for testosterone use and risk for pregnancy and self-administration of injectable contraception have been added to the U.S. SPR.

Testosterone Use and Risk for Pregnancy

  • Counsel that testosterone use might not prevent pregnancy among transgender, gender diverse, and nonbinary persons with a uterus who are using testosterone. Offer contraceptive counseling and services to those who are at risk for and do not desire pregnancy.*

Self-Administration of Subcutaneous Injectable Contraception

  • Self-administered subcutaneous depot medroxyprogesterone acetate (DMPA-SC) should be made available as an additional approach to deliver injectable contraception.* (This recommendation was developed and published in 2021.)[14]
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Content Source:
National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP); Division of Reproductive Health