At a glance
This appendix summarizes recommendations for health care providers on examinations and tests needed before initiation of contraceptive methods. This information comes from the 2024 U.S. Selected Practice Recommendations for Contraceptive Use (U.S. SPR). The U.S. SPR provides recommendations for health care providers that address a selected group of common, yet sometimes complex, issues regarding initiation and use of specific contraceptive methods.
Overview
The examinations and tests noted apply to patients who are presumed to be healthy (Table C1). Those with known medical problems or other special conditions might need additional examinations and tests before being determined to be appropriate candidates for a particular method of contraception. U.S. Medical Eligibility Criteria for Contraceptive Use, 2024 (U.S. MEC) might be useful in such circumstances.[1] The following classification was considered useful in differentiating the applicability of the various examinations and tests:[2]
Class A: Essential and mandatory in all circumstances for safe and effective use of the contraceptive method.
Class B: Contributes substantially to safe and effective use, but implementation may be considered within the public health context, service context, or both; risk of not performing an examination or test should be balanced against the benefits of making the contraceptive method available.
Class C: Does not contribute substantially to safe and effective use of the contraceptive method.
These classifications focus on the relation of the examinations or tests to safe initiation of a contraceptive method. They are not intended to address the appropriateness of these examinations or tests in other circumstances. For example, certain examinations or tests that are not deemed necessary for safe and effective contraceptive use might be appropriate for good preventive health care or for diagnosing or assessing suspected medical conditions. Any additional screening needed for preventive health care can be performed at the time of contraception initiation, and initiation should not be delayed for test results.
No examinations or tests are needed before initiating condoms, spermicides, or vaginal pH modulators. A bimanual examination is necessary for diaphragm fitting. A bimanual examination and cervical inspection are needed for cervical cap fitting.
Table C1. Examinations and tests needed before initiation of contraceptive methods
Abbreviations: BMI = body mass index; CHC = combined hormonal contraceptive; Cu-IUD = copper intrauterine device; DMPA = depot medroxyprogesterone acetate; IUD = intrauterine device; LNG-IUD = levonorgestrel intrauterine device; POP = progestin-only pill; STI = sexually transmitted infection; U.S. MEC = U.S. Medical Eligibility Criteria for Contraceptive Use.
* In instances in which blood pressure cannot be measured by a provider, blood pressure measured in other settings can be reported by the patient to their provider.
† Weight (BMI) measurement is not needed to determine medical eligibility for any methods of contraception because all methods can be used (U.S. MEC 1) or generally can be used (U.S. MEC 2) among patients with obesity (BMI ≥30 kg/m2). However, measuring weight and calculating BMI at baseline might be helpful for discussing concerns about any changes in weight and whether changes might be related to use of the contraceptive method.
§ A bimanual examination (not cervical inspection) is needed for diaphragm fitting.
¶ Most patients do not require additional STI screening at the time of IUD placement. If a patient with risk factors for STIs has not been screened for gonorrhea and chlamydia according to CDC’s Sexually Transmitted Infections Treatment Guidelines, screening may be performed at the time of IUD placement, and placement should not be delayed. Patients with current purulent cervicitis or chlamydial infection or gonococcal infection should not undergo IUD placement (U.S. MEC 4).