Appendix C: Examinations and Tests Needed Before Initiation of Contraceptive Methods

Examination

Blood pressure

C

C

C

A*

C

C

C

C

Weight (BMI) (weight [kg]/height [m]2)

—†

—†

—†

—†

—†

C

C

C

Clinical breast examination

C

C

C

C

C

C

C

C

Bimanual examination and cervical inspection

A

C

C

C

C

C

A§

C

Glucose

C

C

C

C

C

C

C

C

Lipids

C

C

C

C

C

C

C

C

Liver enzymes

C

C

C

C

C

C

C

C

Hemoglobin

C

C

C

C

C

C

C

C

Thrombogenic mutations

C

C

C

C

C

C

C

C

Cervical cytology (Papanicolaou smear)

C

C

C

C

C

C

C

C

STD screening with laboratory tests

—¶

C

C

C

C

C

C

C

Abbreviations: BMI = body mass index; CHC = combined hormonal contraceptive; Cu-IUD = copper-containing intrauterine device; DMPA = depot medroxyprogesterone acetate; HIV = human immunodeficiency virus; LNG-IUD = levonorgestrel-releasing intrauterine device; POP = progestin-only pill; STD = sexually transmitted disease; U.S. MEC = U.S. Medical Eligibility Criteria for Contraceptive Use, 2010.

* In cases in which access to health care might be limited, the blood pressure measurement can be obtained by the woman in a nonclinical setting (e.g., pharmacy or fire station) and self-reported to the 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 obese women (Box 2). However, measuring weight and calculating BMI at baseline might be helpful for monitoring any changes and counseling women who might be concerned about weight change perceived to be associated with their contraceptive method.

§ A bimanual examination (not cervical inspection) is needed for diaphragm fitting.

¶ Most women do not require additional STD screening at the time of IUD insertion if they have already been screened according to CDC's STD Treatment Guidelines (available at http://www.cdc.gov/std/treatment). If a woman has not been screened according to guidelines, screening can be performed at the time of IUD insertion and insertion should not be delayed. Women with purulent cervicitis or current chlamydial infection or gonorrhea should not undergo IUD insertion (U.S. MEC 4). Women who have a very high individual likelihood of STD exposure (e.g., those with a currently infected partner) generally should not undergo IUD insertion (U.S. MEC 3). For these women, IUD insertion should be delayed until appropriate testing and treatment occurs.