Committee Opinion Header
Number 505, September 2011


Committee on Gynecologic Practice
Long-Acting Reversible Contraception Working Group
This document reflects emerging clinical and scientific advances as of the date issued and is subject to change. The information should not be construed as dictating an exclusive course of treatment or procedure to be followed.

PDF Format

Understanding and Using the US Medical Eligibility Criteria for Contraceptive Use, 2010

ABSTRACT: The 2010 U.S. Medical Eligibility Criteria for Contraceptive Use (U.S. MEC) issued by the Centers for Disease Control and Prevention gives comprehensive, evidence-based guidance to clinicians providing family planning services to women, especially women with medical conditions. The American College of Obstetricians and Gynecologists endorses the U.S. MEC and encourages its use by Fellows.


In May 2010, the Centers for Disease Control and Prevention (CDC) issued the U.S. Medical Eligibility Criteria for Contraceptive Use, 2010 (U.S. MEC), which provides comprehensive, evidence-based guidance on contraceptive use (1). The U.S. MEC gives guidance to clinicians providing family planning services to women, especially women with medical conditions. The U.S. MEC recommendations were adapted from guidance previously developed by the World Health Organization (2). Revised recommendations for the use of contraceptive methods during the postpartum period were released in July 2011 (3). This Committee Opinion serves as a guide to understanding and using the 2010 U.S. MEC. The full recommendations are available at http://www.cdc.gov/mmwr/pdf/rr/rr5904.pdf.

In the U.S. MEC, contraceptive methods are classified using four categories based on the safety of the method when used by women with certain characteristics or medical conditions (Box 1). Clinicians can use these categories when assessing the appropriateness of contraceptive methods for women with specific medical conditions or characteristics. In addition, clinicians should consider the severity of a woman's medical condition; her personal preference; and the effectiveness, acceptability, and availability of alternative methods.

Box 1. Categories for 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 risksusually outweigh the advantages of using the method.

4 = A condition that represents an unacceptable health risk if the contraceptive method is used.

Farr S, Folger SG, Paulen M, Tepper N, Whiteman M, Zapata L, et al. U S. Medical Eligibility Criteria for Contraceptive Use, 2010: adapted from the World Health Organization Medical Eligibility Criteria for Contraceptive Use, 4th edition. Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion; Centers for Disease Control and Prevention (CDC); MMWR Recomm Rep 2010;59(RR-4):1–86. Available at: http://www.cdc.gov/mmwr/pdf/rr/rr5904.pdf. Retrieved May 26, 2011

Category 1 indicates that no restrictions exist for use of a contraceptive method by women with a given characteristic or medical condition, whereas Category 2 indicates that the method can be used but that individualization and careful follow-up may be required. Category 3indicates that use of a particular method is generally not recommended unless other methods are unavailable or unacceptable. Provision of a method to a woman with a characteristic or condition for which the contraceptive is classified as Category 3 requires clinical judgment. Category 4 indicates that the method should not be used in women with a specific characteristic or condition becauseit may confer an unacceptable health risk.

For example, the use of combined oral contraceptives (OCs) would be classified as Category 2 for smokers younger than 35 years (Table 1). However, the use of combined OCs by a woman aged 35 years or older who smokes fewer than 15 cigarettes per day is classified as Category 3 and is not generally recommended unless other methods are unavailable or unacceptable to her. A woman aged 35 years or older who smokes 15 or more cigarettes per day should not use combined OCs because of unacceptable health risks, primarily the risk of myocardial infarction and stroke (Category 4). The full recommendations are available at http://www.cdc.gov/mmwr/pdf/rr/rr5904.pdf. Updates and supporting information for clinicians are available at http://www.cdc.gov/reproductivehealth/UnintendedPregnancy/USMEC.htm.

Table 1. Summary of Classifications for Hormonal Contraceptive Methods and Intrauterine Devices

Table 1 Part 1

Table 1 Part 2

Table 1 Part 3

Table 1 Part 4

Table 1 Part 5

Abbreviations: AIDS, acquired immunodeficiency syndrome; ARV, antiretroviral; BMI, body mass index; C, continuation of contraceptive method; COC, combined oral contraceptive; DM, diabetes mellitus; DVT, deep venous thrombosis; β-hCG, beta-human chorionic gonadotropin; HIV, human immunodeficiency virus; I, initiation of contraceptive method; IUD, intrauterine device; LNG IUD, levonorgestrel-releasing IUD; NA, not applicable; P, combined hormonal contraceptive patch; PE, pulmonary embolism; R, combined hormonal vaginal ring; STI, sexually transmitted infection; VTE, venous thromboembolism.

*Condition that exposes a woman to increased risk as a result of an unintended pregnancy.

Please see the complete guidance for a clarification to this classification. www.cdc.gov/reproductivehealth/usmec.

Please refer to the U.S. Medical Eligibility Criteria for Contraceptive Use guidance related to drug interactions at the end of this chart.

§See Tepper N, Curtis KM, Jamieson DJ, Marchbanks PA. Update to CDC's U.S. medical eligibility criteria for contraceptive use, 2010: revised recommendations for the use of contraceptive methods during the postpartum period. Centers for Disease Control and Prevention (CDC). MMWR Morb Mortal Wkly Rep 2011;60:878–83. Available at: http://www.cdc.gov/mmwr/pdf/wk/mm6026.pdf. Retrieved July 7, 2011. ||Clarification: For women with other risk factors for venous thromboembolism, these risk factors may increase the classification to a “4”; for example, see Smoking, DVT/PE, Thrombogenic Mutations, and Peripartum Cardiomyopathy.

Modified from Farr S, Folger SG, Paulen M, Tepper N, Whiteman M, Zapata L, et al. U. S. Medical Eligibility Criteria for Contraceptive Use, 2010: adapted from the World Health Organization Medical Eligibility Criteria for Contraceptive Use, 4th edition. Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion; Centers for Disease Control and Prevention (CDC); MMWR Recomm Rep 2010;59(RR-4):1–86. Available at: http://www.cdc.gov/mmwr/pdf/rr/rr5904.pdf. Retrieved May 26, 2011.

The U.S. MEC recommendations also address the initiation and continued use of methods. Continuation criteria become relevant when a woman develops a medical condition while already using a contraceptive method. When recommendation categories differ for initiation and continuation of a given method, these differences are noted (Table 1).

The American College of Obstetricians and Gynecologists endorses the U.S. MEC and encourages its use by Fellows. As the CDC notes, “…these recommendations are meant to be a source of clinical guidance; health care providers should always consider the individual clinical circumstances of each person seeking family planning services” (1).

References

  1. Centers for Disease Control and Prevention. United States medical eligibility criteria for contraceptive use. Available at: http://www.cdc.gov/reproductivehealth/UnintendedPregnancy/USMEC.htm. Retrieved May 26, 2011.
  2. World Health Organization. Medical eligibility criteria for contraceptive use. 4th ed. Geneva: WHO; 2009. Available at http://whqlibdoc.who.int/publications/2010/9789241563888_eng.pdf. Retrieved May 26, 2011.
  3. Tepper N, Curtis KM, Jamieson DJ, Marchbanks PA. Update to CDC's U.S. medical eligibility criteria for contraceptive use, 2010: revised recommendations for the use of contraceptive methods during the postpartum period. Centers for Disease Control and Prevention (CDC). MMWR Morb Mortal Wkly Rep 2011;60:878–83. Available at: http://www.cdc.gov/mmwr/pdf/wk/mm6026.pdf. Retrieved July 7, 2011.

Copyright September 2011 by the American College of Obstetricians and Gynecologists, 409 12th Street, SW, PO Box 96920, Washington, DC 20090-6920. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, posted on the Internet, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permission from the publisher. Requests for authorization to make photocopies should be directed to: Copyright Clearance Center, 222 Rosewood Drive, Danvers, MA 01923, (978) 750-8400.

ISSN 1074-861X

Understanding and using the U.S. Medical Eligibility Criteria for Contraceptive Use, 2010. Committee Opinion No. 505. American College of Obstetricians and Gynecologists. Obstet Gynecol 2011;118:754–60.