Medical Eligibility Criteria

The World Health Organization (WHO) periodically convenes an Expert Working Group to make evidence-based recommendations for who can safely use a

Table 26-2 Preferred Contraceptive Options for Select Patient Groups

Patient type

Preferred options

Comments

Adolescent

DMPA, implant, COC, or IUC plus condoms

IUCs are excellent option currently underused in adolescents.

Potentially noncompliant

DMPA, implant, patch, ring, IUC

HIV and STD risk

Condom plus any other form of contraception

Postpartum and lactating

DMPA, implant, POP, IUC, LAM up to 6 months if specific criteria met

COCs can decrease quality and quantity of breast milk, but only if started before establishment of lactation.

Smoker >35 years old

DMPA, implant, POP, IUC, barrier methods

ECs contraindicated.

Diabetic

DMPA, implant, IUC, barrier methods

ECs appropriate in young normotensive well-controlled diabetic women.

Hypertensive

DMPA, implant, POP, IUC barrier methods

ECs appropriate in young well-controlled nonsmoking hypertensive women.

History of stroke/TIA

IUC, barrier methods

ECs contraindicated; may consider progestin-only methods.

History of thromboembolism

IUC, barrier methods

ECs contraindicated; may consider progestin-only methods.

Coronary artery disease

IUC, implant, barrier methods

ECs contraindicated, may consider progestin-only methods.

Mitral valve prolapse

DMPA, implant, IUC. COC; patch or ring if asymptomatic

Polycystic ovarian syndrome

COC, ring, patch, levonorgestrel IUC

COCs best shown to suppress androgen excess; levonorgestrel IUC provides excellent endometrial protection.

Sickle cell disease

DMPA, barrier methods

DMPA shown to decrease frequency of crises.

Gallbladder disease

DMPA, implant, IUC

COCs may accelerate progression.

Taking anticonvulsants or other hepatic inducers

DMPA, IUC

Efficacy of COCs, POPs, and implants may be reduced.

Desires long-term reversible contraception

DMPA, implants, IUC

Desires short-term reversible contraception

COC, POP, patch, ring, barrier methods

Desires convenience

DMPA, implant, IUC

Desires permanent contraception; no interest in future fertility

Vasectomy or tubal ligation

Data from World Health Organization. Medical eligibility criteria for contraceptive use 2004, and 2008 Update of the Guide (WHO website).

COC, Combined (combination) oral contraceptive; DMPA, depot medroxyprogesterone acetate; IUC, intrauterine contraceptive; POP, progestin-only pill; LAM, lactational amenorrhea method; ECs, estrogen-containing contraceptives.

STD, Sexually transmitted disease; HIV, human immunodeficiency virus; TIA, transient ischemic attack.

contraceptive method. These criteria can be found on the WHO website.

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