Clinical Practice: Centers for Disease Control and Prevention Updates Medical Eligibility Criteria Guidelines
In August, the Centers for Disease Control and Prevention (CDC) released updates to the US Medical Eligibility Criteria (MEC) and the Selected Practice Recommendations (SPR) for Contraceptive Use. These updates reflect the newest research and data on contraceptive methods.
The updated MEC guidelines highlight Long-acting Reversible Contraception (LARC) methods by listing them first instead of the previous focus on hormonal contraception methods.
Notably, recommendations for the use of hormonal birth control methods in breastfeeding mothers are provided based on days postpartum. Combined hormonal methods are listed as Category 4 less than 21 days postpartum, Category 3 during days 21-30 and Category 2 after 30 days.
Progestin-only methods are listed as Category 2 until 30 days postpartum, when they drop to Category 1 for breastfeeding mothers. For mothers who are not breastfeeding, progestin-only methods are listed as Category 1 during the postpartum period, while combined methods are listed as Category 4 until 21 days postpartum and descend until reaching Category 1 after 42 days postpartum. For information on the MEC categorization system, please see Box 1 below.
The updated recommendations also clarify the use of a range of contraceptive methods in patients with certain medical conditions, such as obesity, pregnancy, multiple sclerosis, migraines, and liver disease.
Updates to the SPR focused on the use of ulipristal acetate (UPA) as emergency contraception, and subsequent contraceptive use. The CDC now recommends that when using UPA as emergency contraception, patients should wait five days before beginning a new contraceptive method, with the exception of Depo shots and LARC devices, which can be considered for same day use. Additionally, following the use of UPA as emergency contraception, patients should abstain from sex or use a barrier method during the first seven days of hormonal contraception use or until the next menses.
The SPR also includes new recommendations for the use of medication during IUD insertion, including suggesting the use of a paracervical block with lidocaine at the time of insertion to reduce pain. The updated guidelines also suggest that Misoprostol, while not recommended for routine use, can be used in certain cases, such as if a patient has previously had an unsuccessful attempt at insertion.
Box 1: Categories of medical eligibility criteria for contraceptive use
1 = A condition for which there is no restriction for the use of the contraceptive method.
2 = A condition for which the advantages of using the method generally outweigh the theoretical or proven risks.
3 = A condition for which the theoretical or proven risks usually outweigh the advantages of using the method.
4 = A condition that represents an unacceptable health risk if the contraceptive method is used.
Curtis KM, Tepper NK, Jatlaoui TC, et al. U.S. Medical Eligibility Criteria for Contraceptive Use, 2016. MMWR Recomm Rep 2016;65(No. RR-3):1–104. DOI: http://dx.doi.org/10.15585/mmwr.rr6503a1
For more information, please refer to the 2016 U.S. Medical Eligibility Criteria (MEC) and the Selected Practice Recommendations (SPR) for Contraceptive Use.