Eligibility Criteria For Contraceptive Use Research Articles

U.S. Medical Eligibility Criteria for Contraceptive Use, 2024.

The 2024 U.S. Medical Eligibility Criteria for Contraceptive Use (U.S. MEC) comprises recommendations for the use of specific contraceptive methods by persons who have certain characteristics or medical conditions. These recommendations for health care providers were updated by CDC after review of the scientific evidence and a meeting with national experts in Atlanta, Georgia, during January 25-27, 2023. The information in this report replaces the 2016 U.S. MEC (CDC. U.S. Medical Eligibility Criteria for Contraceptive Use, 2016. MMWR 2016:65[No. RR-3]:1-103). Notable updates include 1) the addition of recommendations for persons with chronic kidney disease; 2) revisions to the recommendations for persons with certain characteristics or medical conditions (i.e., breastfeeding, postpartum, postabortion, obesity, surgery, deep venous thrombosis or pulmonary embolism with or without anticoagulant therapy, thrombophilia, superficial venous thrombosis, valvular heart disease, peripartum cardiomyopathy, systemic lupus erythematosus, high risk for HIV infection, cirrhosis, liver tumor, sickle cell disease, solid organ transplantation, and drug interactions with antiretrovirals used for prevention or treatment of HIV infection); and 3) inclusion of new contraceptive methods, including new doses or formulations of combined oral contraceptives, contraceptive patches, vaginal rings, progestin-only pills, levonorgestrel intrauterine devices, and vaginal pH modulator. The recommendations in this report are intended to serve as a source of evidence-based clinical practice guidance for health care providers. The goals of these recommendations are to remove unnecessary medical barriers to accessing and using contraception and to support the provision of person-centered contraceptive counseling and services in a noncoercive manner. Health care providers should always consider the individual clinical circumstances of each person seeking contraceptive services. This report is not intended to be a substitute for professional medical advice for individual patients; when needed, patients should seek advice from their health care providers about contraceptive use.

What’s inside matters: an assessment of the family planning content of digital self-care platforms

BackgroundDigital technology has proliferated rapidly in low- and middle-income countries in recent decades. This trend will likely persist as costs decrease, dramatically expanding access to reproductive health and family planning (FP) information. As many digital tools aim to support informed choice among individuals with unmet contraceptive need, it is essential that high-quality information is provided. We set out to assess the accuracy and comprehensiveness of FP content in select user-facing digital self-care platforms.MethodsWe identified 29 digital tools in circulation between 2018–2021 and selected 11 that met our eligibility criteria for analysis. Referencing global guidance documents such as the Family Planning Handbook, Medical Eligibility Criteria for Contraceptive Use, and the Digital Health for Social and Behavior Change High Impact Practice Brief, we developed an original rubric outlining 12 key content areas necessary to support informed, person-centered counseling. We applied this to each tool, enabling assignment of a numerical score that represents content accuracy and comprehensiveness across the 12 key areas.ResultsFP content of digital tools varied greatly in accuracy and comprehensiveness. Of the 12 identified key content areas, 5 were included in all 11 tools, while 6 were addressed inconsistently or not at all. Four content areas were the most accurate and comprehensive: complete list of modern methods, duration of protection, dual method use, and return to fertility. The lowest scoring content areas were side effect management, non-contraceptive benefits, effectiveness, side effects, and instructions for use. ConclusionsComplete, accurate, and evidence-based FP content is a foundational element of quality digital self-care. Inaccuracies and omissions can impact individual user experiences and decision-making in critical ways. FP content quality should be verified before digital tools are scaled or researched at the programmatic level. From this exercise, we developed a checklist for use in conjunction with global guidance documents to improve future FP content of user-facing digital tools.

National medical eligibility criteria for contraceptive use 2023: review

Individual sexual and reproductive life management has been сonfirmed by medical and state communities since 1990s. Every citizen officially received rights for access to appropriate goods and services. Such international agreements as 1994 International Conference on Population and Development (ICPD, Cairo, Egypt) and 2004 WHO Reproductive health strategy, estimated reproductive health and family planning as priorities. Worldwide agreement on the 2005 summit declares achieving of female reproductive health before year 2015 as worldwide progress.WHO created complex of international eligibility criteria for male and female contraception with the aim of medical aid improvement. According to WHO plan, those criteria should be used by countries considering policy, needs, priorities and resources of national healthcare programs. For example, USA, United Kingdom, Russia etc. have successfully adopted medical eligibility criteria for contraception on the national level.The present review is summary product created by interdisciplinary expert group including representers of federal and regional healthcare establishments, medical universities, and international medical organizations.

GYNECOLOGY AND OBSTETRICS RESIDENTS' KNOWLEDGE OF HORMONAL CONTRACEPTION IN SPECIAL SITUATIONS

Objective: To assess the knowledge of gynecology and obstetrics residents about hormonal contraception in special situations, according to the World Health Organization (WHO) guide Eligibility Criteria for Contraceptive Use. Method: This was a cross-sectional, descriptive study, in which a questionnaire was administered to resident doctors in Gynecology and Obstetrics at the Santa Casa de Misericórdia Foundation in Pará, who were divided according to their year of residency (R1, R2 and R3). Data was collected in a virtual environment using a questionnaire on the Google forms platform. Results: All 57 (100%) of the medical residents participated in the survey, 50 (87.7%) of whom were female, aged between 18 and 29 (61.4%), in their first or second year of residency (35.0% each year). As for the percentage of correct answers per year of residency, it was clear that the first year had the highest rates of correct answers for all contraceptive methods (7.0%), and when analyzing which residents had corrected at least one method in isolation, the second year had the highest number of correct answers (28.0%), although there was no statistical difference in relation to the year of residency and the number of correct answers. When assessing the overall number of correct answers, it was found that the residents were at least aware of some of the main contraceptive methods. Conclusion: The results of this study showed that residents' objective and perceived levels of knowledge regarding the prescription of contraceptives in special situations were insufficient. Thus, the results show the need for medical training when prescribing these drugs.

Thrombotic and Vascular Complications of Oral Contraceptives.

The oral contraceptive pill is the most commonly used form of reversible contraception, as it has significantly grown in popularity in recent years. The 2 types of oral contraceptive pills are combination oral contraceptives, which contain estrogen and progesterone, and progestin-only pills. Both have failure rates of approximately 7.2-9% with typical use and are safe for most patients. However, several thrombotic and vascular complications have been found to be associated with the usage of oral contraceptive pills, most notably being an increase in blood pressure and thrombosis. Although these complications do not typically affect young, healthy females, they merit concern for patients with a history of hypertension or thrombosis or patients with preexisting risk factors for these conditions. Overall, progestin-only pills are the safer option regarding these complications. Additionally, a complete summary of the medical eligibility criteria for contraceptive use has been created and is regularly updated by the Centers for Disease Control and Prevention. This chart summarizes the recommendations for contraception use by patients with a variety of preexisting conditions or risk factors.

Contraceptive use in patients with gender dysphoria who were assigned female at birth receiving care at a specialty gender-affirming clinic

BackgroundThe Centers for Disease Control and Prevention (CDC) recommend that all patients, regardless of gender identity or sexual orientation, should be offered family planning and contraceptive options without assumptions of sexual behaviors and pregnancy risk. Current research on family planning services for lesbian, gay, bisexual, transgender, and queer or questioning patients is limited, but patients who are sexual or gender minorities are at increased risk for unintended pregnancy. ObjectivesThe objective of this study was to describe contraceptive use in patients assigned female at birth with gender dysphoria at a gender-affirming primary care clinic. MethodsA retrospective descriptive study was conducted. Patients were included if they were 18 to 44 years old, received care at University of New Mexico Truman Health Services in 2019, were diagnosed with gender dysphoria, and were assigned female at birth. Patients were excluded if they had never developed female reproductive organs. Data were collected from the electronic medical records. Potential differences in contraceptive use based on demographic characteristics, having a family planning discussion, and having a contraceptive use discussion were analyzed using chi-square analyses. Potential predictors of contraceptive use were identified using exploratory forward conditional logistic regression and univariate logistic regression analyses. ResultsA total of 163 patients were included; average age was 26.6 years; 71% identified as male, 5% identified as masculine, and 25% identified as nonbinary. Most patients (92%) were prescribed masculinizing therapy (testosterone). Forty-five (28%) patients had documented contraception use; the most common form was permanent contraception (76%). Most patients (68%) did not have any documented contraindications to contraception based on CDC US Medical Eligibility Criteria for contraceptive use. Of 113 patients with a documented sexual orientation, 45 patients (40%) reported having sex with persons who have a penis; only 13 (29%) of those patients had a documented form of contraception. Family planning discussions were documented for 82% of patients. Family planning discussions that specifically addressed contraception were documented in only 49% of patients. However, the odds of a patient having a documented use of contraception was 9.26 times higher when family planning discussions specifically addressed contraception. ConclusionDocumented contraception use was low in people assigned female at birth of childbearing age receiving care at a gender-affirming clinic. Due to increased risks of unintended pregnancy in this population and the teratogenic nature of testosterone, family planning discussion should also include discussions related to contraception, as this was associated with increased contraception use. Additional research is needed to address potential barriers to contraception use in this population.

National medical eligibility criteria for contraceptive use 2023: focus on women's reproductive health: A review

Reproductive health care involves helping families in this area with the provision of the necessary information. This is recognized as a key step in improving the health of men, women and children and is a fundamental human right. Everyone has the right to have access to a correct understanding of reproductive health care, choice of contraceptive method and the opportunity to benefit from scientific progress in this area. Over the past 35 years, significant progress has been made in the development of new contraceptives: the content of hormones in combined oral contraceptives has significantly decreased, inert intrauterine contraceptives have been replaced by more progressive, levonorgestrel-containing ones including low-dose generation. Combined hormonal compounds were synthesized in the form of injections, patches and vaginal rings, progestogen implantable and injectable contraceptives. Women who use contraceptives must take into account the state of health (including the presence of endocrine pathology) in order to use them without harm to their health. Based on the World Health Organization Medical Eligibility Criteria for Contraceptive Methods 2015, the Russian Medical Eligibility Criteria for Contraceptive Methods 2023 is designed to become an important tool in daily practice of doctors.

Differences In The Effectiveness Of Abpk And Klop Kb Counseling Against Kb Mkjp Elections

According to the United States Census Bureau, the world population in 2021 will be 74 million people. In Asia in 2021 the population will reach 4.688 billion. While Indonesia ranks fourth with the largest population in the world of 273.5 million people. The impact of the population explosion is increasing poverty and hunger, malnutrition in children under five, maternal and child mortality, increased unemployment. One of the methods used to reduce the rate of population growth is through birth control by means of family planning. There are two types of Family Planning Counseling Modules, namely using a Family Planning Decision Making Tool and screening of medical eligibility criteria for contraceptive use (KLOP Wheel). Knowing the differences in the effectiveness of ABPK and KLOP KB counseling on the selection of KB MKJP. Analytics with cross sectional design. The sample in this study were all family planning acceptors at the Pasir Jaya Tangerang Health Center in October 2022 as many as 56 people, the sampling technique was total sampling. Most of the respondents were aged 20-35 years (62.5%), secondary education (50.0%) and multiparous parity (89.3%). The family planning acceptors in the ABPK counseling group mostly chose injections 53.6%, and in the KLOP counseling group most chose the IUD 78.6%. There is a difference in the effectiveness of ABPK and KLOP KB counseling on the selection of KB MKJP (p.value 0.001). There is a difference in the effectiveness of ABPK and KLO KB counseling on the selection of KB MKJP (p.value 0.001). For family planning acceptors, they should be able to carefully consider the choice of contraceptives in order to be able to determine the choice of long-term family planning methods (MKJP).

Incidence of Post-Placental IUD Expulsion in Women of Childbearing Age

Background:The United States Medical Eligibility Criteria for Contraceptive Use and the American College of Obstetricians and Gynecologists recommend insertion of an Intra Uterine Device (IUD) immediately after delivery, due to the low complication rate. Postplacental IUD insertion is the insertion of an IUD immediately after delivery of the placenta during vaginal delivery. This method serves to reduce the number of births. However, post-placental insertion is believed to have a high expulsion rate. which is around 2-27%Purpose : To analyze and summarize the results of one study with another regarding the incidence of postplacental IUD expulsion in women of childbearing ageMethod:The research method used is literature review by searching for articles related to the theme taken from several search engines namely Pubmed, and Google Scholar and Search is done using the keyword IUD expulsion, Postplacental, women of childbearing age.Results: the installation of post placental IUDs has the opportunity to experience an expulsion eventConclusion: From all the journals that have been reviewed It can be concluded that the installation of post placental IUD has the opportunity to experience an expulsion event.

Ultrasound Imaging of a Bicornuate Uterus with a Pregnancy and an Intrauterine contraceptive device in different Horns: A Case Report from Zimbabwe

A bicornuate uterus is a congenital abnormality that results from the incomplete lateral fusion of the two müllerian ducts. The WHO eligibility criteria for contraceptive use, states that the use of intrauterine devices (IUCDs) is contraindicated for women with uterine abnormalities. However, in most cases, the presence of the bicornuate uterus is not known at the time of IUCD insertion. We herein report a case of a 41-year-old woman who had a bicornuate uterus with an IUCD in situ in the left horn and a live pregnancy in the right horn. The aim of this case report is to highlight the important role ultrasound imaging can play in the diagnosis of congenital uterine abnormalities in patients using IUCDs. Furthermore, the report also discusses the ultrasound imaging techniques that a diagnostician can adopt to optimize the diagnosis.

Ultrasound Imaging of a Bicornuate Uterus with a Pregnancy and an Intrauterine contraceptive device in different Horns: A Case Report from Zimbabwe

A bicornuate uterus is a congenital abnormality that results from the incomplete lateral fusion of the two müllerian ducts. The WHO eligibility criteria for contraceptive use, states that the use of intrauterine devices (IUCDs) is contraindicated for women with uterine abnormalities. However, in most cases, the presence of the bicornuate uterus is not known at the time of IUCD insertion. We herein report a case of a 41-year-old woman who had a bicornuate uterus with an IUCD in situ in the left horn and a live pregnancy in the right horn. The aim of this case report is to highlight the important role ultrasound imaging can play in the diagnosis of congenital uterine abnormalities in patients using IUCDs. Furthermore, the report also discusses the ultrasound imaging techniques that a diagnostician can adopt to optimize the diagnosis.

P076Contraceptive use by females with chronic medical conditions in a large integrated healthcare system

<h3>Objectives</h3> Females with chronic medical conditions (CMCs) face greater risk of pregnancy complications yet have higher risk of unplanned pregnancy than healthy females. To identify opportunities to optimize care, we investigated differences in contraceptive use among those with CMCs vs. those without these conditions within Kaiser Permanente Mid-Atlantic States (KPMAS). <h3>Methods</h3> We conducted a retrospective cohort study using electronic medical record data. We included females aged 15–44 enrolled within KPMAS between January 1, 2021 and December 31, 2021 without hysterectomy or bilateral oophorectomy. We defined CMCs using the US Medical Eligibility Criteria for Contraceptive Use and identified contraception through ICD-10 and CPT codes for intrauterine device (IUD), implant, female sterilization, and injectables; and pharmacy dispensing data for pills, patches, and rings. Controlling for sociodemographic differences, we used multinomial logistic regression to determine the odds of using each tier of contraception vs. none of the specified tiers for those with CMCs versus those without. <h3>Results</h3> Of 128,340 patients, 13,672 (10.7%) had CMCs with hypertension, diabetes, and sickle cell disease most common. 44% of those with CMCs used one of the specified methods versus 40% of those without (OR, 1.19; 95% CI, 1.15–1.23). Those with CMCs were more likely to be >35yo, Black, and have Medicaid (p<0.01) and to use female sterilization (aOR 1.79, 95% CI 1.66-1.93) or long-acting reversible contraception (aOR 1.32, 95% CI 1.26-1.39). <h3>Conclusions</h3> In our diverse cohort, females with CMCs were more likely to use effective contraception than their healthy counterparts, although there may be room for improvement given their unique health risks.

Персонализированный подход к пациентам с обильными менструальными кровотечениями в репродуктивном возрасте

The number of women suffering from heavy menstrual bleeding, according to various publications, is not decreasing and makes up about 20% of gynecological patients. Such patients, in the absence of predictive intervention by a gynecologist, are at risk of developing somatic diseases associated primarily with iron deficiency. At the same time, the correction of heavy menstrual bleeding requires a differential approach to the choice of treatment, considering the patient’s age and reproductive plans, the cause of bleeding, as well as an assessment of the benefit-risk ratio of the drug and its additional advantages. Objective. To study the efficacy of using a combined oral contraceptive (COC) containing 2 mg chlormadinone acetate / 0.03 mg ethinylestradiol in patients of reproductive age with idiopathic heavy menstrual bleeding leading to iron deficiency who need reliable contraception. Patients and methods. The study included 67 women of reproductive age between 18 and 45 years (mean age 27.2 ± 0.5 years) who visited a gynecologist with a complaint of heavy menstrual bleeding accompanied by latent iron deficiency. After considering the safety of COC according to the Medical Eligibility Criteria for Contraceptive Use (World Health Organization, 2015), all women were prescribed Belara (2 mg chlormadinone acetate / 0.03 mg ethinylestradiol) for 6 months with an assessment of efficacy, safety, and possible prolongation of its use. Results. The administration of Belara containing 2 mg chlormadinone acetate/0.03 mg ethinylestradiol demonstrated its efficacy as means of contraception and reducing menstrual blood loss, which contributes to the normalization of iron indices in women. Among 51 (76.1%) patients with latent iron deficiency, 49 (96%) had recovery of ferritin levels (&gt;30 mg/dL) after taking Belara. Meanwhile, the frequency of adverse reactions did not exceed 15%. They were represented by scanty acyclic uterine bleeding (4.5%), increased sensitivity of the breasts (7.5%), nausea (1.5%), and headache (1.5%). All adverse reactions did not require additional therapy or drug withdrawal. Conclusion. Belara may be recommended for women of reproductive age with heavy menstrual bleeding accompanied by latent iron deficiency who need reliable contraception. Key words: heavy menstrual bleeding, latent iron deficiency, combined oral contraceptives, ethinylestradiol, chlormadinone acetate

Exploring Attitudes, Beliefs and Behavior Towards Hormonal Birth Control Among Female Patients with Sickle Cell Disease through Semi-Structured Interviews

▪Background: Sickle cell disease (SCD) is an inherited, autosomal recessive disorder and one way to decrease the risk of transmission of the disease is through informed reproductive choices. The U.S. Medial Eligibility Criteria for Contraceptive Use advises that the benefits of using hormonal contraceptives usually outweigh the risks for women with SCD. Recommendations for contraceptive use for individuals with sickle cell disease do not discourage the use of any specific contraceptives and identify sickle cell disease as a condition that exposes the woman to increased risk as a result of unintended pregnancy. Research indicates that women with SCD use hormonal contraceptives at lower rates than women without SCD.Objective: We sought to understand women with SCD knowledge, attitudes, and practices around hormonal contraceptives.Methods: African American females 18 and older with SCD were recruited from a sickle cell clinic in Atlanta, Georgia. We administered semi-structured interviews to examine the intersection of sickle cell and reproductive health. These semi-structured interviews explored participants' knowledge and attitudes towards hormonal contraceptives, as well as their personal experiences using hormonal contraceptives.Results: Seventeen women were interviewed on this topic. All but two of the participants indicated they had previously used hormonal contraceptives, but most of the women were not currently using hormonal birth control. Some of the participants had positive thoughts towards hormonal birth control because it prevents pregnancy.Birth control period. I am all for it. I feel like that is a good prevention of having unplanned pregnancies and whatever.Women cited positive experiences with hormonal birth control because it helped with heavy menstrual bleeding and decreased the number of sickle cell pain crises they experienced.I had depo before. It just made me gain weight and my cycles were off balance but it kind of helped with the Sickle Cell crisis a little bit.I would have pain crisis every time I had a menstrual cycle so my doctor told me to go to a gynecologist to get onto a birth control so that kind of decreased the amount of crisis that I was getting.Some of the participants had negative perceptions of hormonal birth control. Some were wary of it altogether. Most of them cited the side effects associated with hormonal birth control as the main reason they did not use them.I don't think any women should be on them just because of all the stuff in it. Some stuff they do not tell you what is in it and the weight gain and all the side effects I don't like them.That's why I don't like them because of the symptoms that I had. I wason Depo and I bleed for two months straight. And then I tried another one.Some green pill I don't know. I tried the implant. Like I said all the side effectsI didn't like them. I didn't like when I had side effects with it.Participants had specific concerns about the side effects related to menstrual bleeding and the intersection between contraceptive and sickle cell.I know they can just regulate your menstrual cycle. I kind of feel like that's unnatural. I think God put that in place for a reason and it needs to clean your body out. I just kind of think that part of it is unnatural and it shouldn't happen.I actually had to get one of them took out. The Nexplanon it actually caused a blood clot which is dangerous for a Sickle Cell patient.Right now I have an IUD and at first it was giving me back problems but I think it was just associated with Sickle Cell. So I think maybe it can trigger a Sickle Cell crisis sometimes.Conclusion: Our study findings indicate that women with SCD have low utilization of hormonal birth control with concerns for side effects caused by, and a general distrust of, hormonal contraception. However, some women also acknowledge that hormonal contraception can help prevent unplanned pregnancy, which not only may lead to unintended transmission of SCD, but also increased health risks to the woman. Providers caring for women with SCD may be able to better support them by adopting a patient-centered approach to contraceptive counseling. Seeking to clarify women's reproductive goals, contraceptive priorities and concerns, as well as correcting misinformation and reassuring women about hormonal contraceptive safety for women with SCD may be beneficial. DisclosuresNo relevant conflicts of interest to declare.

Contraindications to Hormonal Contraception Among Postpartum Women in Texas.

To examine the prevalence of contraindications to hormonal contraception among postpartum women. Low-income postpartum women who planned to delay childbearing for 2 years or longer after delivery were recruited for a prospective cohort study from eight Texas hospitals. Women self-reported health conditions that corresponded to category 3 and 4 contraindications to combined hormonal contraception and progestin-only methods, based on the Centers for Disease Control and Prevention's 2016 Medical Eligibility Criteria for Contraceptive Use. We used mixed-effects Poisson regression models to assess characteristics associated with reporting any contraindication 6 months after delivery. We examined the proportion of women who used a contraindicated method. Of 1,452 women who completed the 6-month interview, 19.1% reported a category 3 or 4 contraindication to combined hormonal contraception (16.8% category 4) and 5.4% reported a contraindication to depot medroxyprogesterone acetate (0.1% category 4). Only 0.8% had any category 3 or 4 contraindication to progestin-only pills and 0.6% to the implant. Migraine with aura (12.4%) and hypertension (4.8%) were the most common contraindications. The prevalence of any contraindication was higher among women who were 30 years or older (prevalence ratio 1.45 95% CI 1.21-1.73), overweight (prevalence ratio 1.39, 95% CI 1.07-1.80), obese (prevalence ratio 1.55, 95% CI 1.16-2.07), and insured (prevalence ratio 1.34, 95% CI 1.04-1.74). Compared with U.S.-born Latina women, the prevalence of contraindications was higher among Black women (prevalence ratio 1.37, 95% CI 1.14-1.64) and lower among foreign-born Latina women (prevalence ratio 0.71, 95% CI 0.59-0.86). Among women with contraindications, 28 (10.3%) were using combined hormonal contraception; six (8%) were using a contraindicated progestin-only method. Nearly one in five participants had a category 3 or 4 contraindication to combined hormonal contraception. Patients at higher risk for adverse birth outcomes are more likely to have contraindications. Clinicians should counsel on contraception and contraindications prenatally to facilitate the most informed postpartum decision.

Combined hormonal contraceptives use among women with contraindications according to the WHO criteria: A systematic review

IntroductionCombined hormonal contraceptives (CHC), containing estrogen, remain the most popular choice of contraceptive among women. While the method offers many benefits, the use of CHC involves potential health risks. The aim of this study was to analyze the available evidence on the prevalence of CHC use among women with contraindications to their use according to the WHO recommendations (2015). MethodsPubmed, Lilacs, and Web of Sciences databases were searched. Selection was based on articles that described the use of combined hormonal contraceptives according to the characteristics that are listed as contraindications in WHO medical eligibility criteria for contraceptive use. ResultsA total of 4363 articles were identified and 18 articles were selected for the review. The most prevalent contraindications against use of CHC were systemic arterial hypertension, migraine, and smoking (in women aged 35 years or older). Prevalence rates of contraindications against use of CHC ranged from 5.9% to 41.9%. ConclusionsA high proportion of women still use CHC when contraindicated to do so according to the WHO criteria. Health policies should focus on highlighting the importance of a detailed health evaluation on CHC candidates, to reduce the proportion of inappropriate prescriptions.

Removing Unnecessary Medical Barriers to Contraception: Celebrating a Decade of the U.S. Medical Eligibility Criteria for Contraceptive Use.

In 2010, the Centers for Disease Control and Prevention (CDC) released the U.S. Medical Eligibility Criteria for Contraceptive Use, providing recommendations for health care providers on safe use of contraception for people with certain characteristics or medical conditions. Adapted from World Health Organization guidance, the goal of the recommendations is to remove unnecessary medical barriers to contraception. Over the past decade, CDC has updated recommendations based on new evidence, collaborated with national partners to disseminate and implement the guidelines, and conducted provider surveys to assess changes in attitudes and practices around contraception safety and provision. CDC remains committed to supporting evidence-based guidelines for safe use of contraception, as the basis for improving access to contraception and high-quality family planning services, reducing unintended pregnancy, and improving reproductive health in the United States.

Contraception for Women With Psychiatric Disorders.

Mental health care for women includes decision support to prepare for major life events, including preconception planning for treatment during pregnancy and the postpartum period. The authors discuss contraceptive choices and their effectiveness, side effects, and impact on psychiatric symptoms. The Centers for Disease Control and Prevention's recommendations, Medical Eligibility Criteria for Contraceptive Use, provided the structure for review of contraceptive choices. A search of PsycINFO, PubMed, Embase, and Scopus was conducted for publications on the management of contraception for women with mental illness. Publications were selected if they included, based on the authors' consensus, data supporting evidence-based care important for psychiatrists who treat women desiring contraceptives. The majority of women choose combined oral contraceptives. Although long-acting reversible contraceptives (implants, intrauterine devices) are associated with low failure rates, favorable safety profiles, rapid return to fertility after removal, and few contraindications, they are chosen by only 14% of women. All methods are acceptable for women with depression, although medical comorbidities may dictate a specific type. The impact of hormonal contraceptives on the risk for depression is controversial; however, clinical studies and randomized placebo-controlled trials of women with psychiatric disorders have generally reported similar or lower rates of mood symptoms in hormonal contraceptive users compared with nonusers. Although interactions between psychotropic drugs and contraceptives are rare, clozapine, anticonvulsants, and St. John's Wort are exceptions. Proactive management of mental illness, contraception, and pregnancy improves a woman's capacity to function and optimizes her mental and reproductive health.

Are women using hormonal contraceptives the risk-takers?

Hemmingsen CH, Kjaer SK, Jezek AH, Verhulst FC, Pagsberg AK, Kamper-Jorgensen M, et al. Maternal use of hormonal contraception and risk of childhood ADHD: a nationwide population-based cohort study. Eur J Epidemiol. 2020. https://doi.org/10.1007/s10654-020-00673-w. Article Google Scholar Curtis KM, Tepper NK, Jatlaoui TC, Berry-Bibee E, Horton LG, Zapata LB, et al. US medical eligibility criteria for contraceptive use, 2016. Morb Mortal Weekly Rep Recomm Rep. 2016;65(3):1–103. Google Scholar Rosendaal F, Helmerhorst F, Vandenbroucke J. Oral contraceptives, hormone replacement therapy and thrombosis. ThromboHaemost. 2001;86(1):112–23. CAS Google Scholar Gierisch JM, Coeytaux RR, Urrutia RP, Havrilesky LJ, Moorman PG, Lowery WJ, et al. Oral contraceptive use and risk of breast, cervical, colorectal, and endometrial cancers: a systematic review. Cancer EpidemiolPrevBiomark. 2013;22(11):1931–43. Google Scholar Del Pup L, Codacci-Pisanelli G, Peccatori F. Breast cancer risk of hormonal contraception: Counselling considering new evidence. Crit Rev Oncol/Hematol. 2019;137:123–30. Article Google Scholar Aleknaviciute J, Tulen JH, De Rijke YB, Bouwkamp CG, Van der Kroeg M, Timmermans M, et al. Thelevonorgestrel-releasing intrauterine device potentiates stress reactivity. Psychoneuroendocrinology. 2017;80:39–45. CAS Article Google Scholar Schendel DE, Bresnahan M, Carter KW, Francis RW, Gissler M, Gronborg TK, et al. The international collaboration for autism registry epidemiology (iCARE): multinational registry-based investigations of autism risk factors and trends. J Autism DevDisord. 2013;43(11):2650–63. Article Google Scholar Marcell AV, Burstein GR. Sexual and reproductive health care services in the pediatric setting. Pediatrics. 2017;140(5). Kooij SJ, Bejerot S, Blackwell A, Caci H, Casas-Brugue M, Carpentier PJ, et al. European consensus statement on diagnosis and treatment of adult ADHD: the European Network Adult ADHD. BMC Psychiatry. 2010;10(1):67. Article Google Scholar Adler LD, Nierenberg AA. Review of medication adherence in children and adults with ADHD. Postgrad Med. 2010;122(1):184–91. Article Google Scholar Dehlendorf C, Krajewski C, Borrero S. Contraceptive counseling: best practices to ensure quality communication and enable effective contraceptive use. ClinObstetGynecol. 2014;57(4):659. Google Scholar Download references Sumner and Esther Feldberg Chair in Maternal and Child Health, Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, 677 Huntington Ave., 6th floor, Boston, MA, 02115, USA Henning Tiemeier You can also search for this author in PubMed Google Scholar Correspondence to Henning Tiemeier. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. Reprints and Permissions Tiemeier, H. Are women using hormonal contraceptives the risk-takers?. Eur J Epidemiol (2020). https://doi.org/10.1007/s10654-020-00686-5 Download citation Received: 04 September 2020 Accepted: 08 September 2020 Published: 23 September 2020 DOI: https://doi.org/10.1007/s10654-020-00686-5

Update to U.S. Medical Eligibility Criteria for Contraceptive Use, 2016: Updated Recommendations for the Use of Contraception Among Women at High Risk for HIV Infection.

"U.S. Medical Eligibility Criteria for Contraceptive Use" (U.S. MEC) 2016 provides evidence-based guidance for the safe use of contraceptive methods among U.S. women with certain characteristics or medical conditions (1). The U.S. MEC is adapted from global guidance from the World Health Organization (WHO) and kept up to date through continual review of published literature (1). CDC recently evaluated the evidence and the updated WHO guidance on the risk for human immunodeficiency virus (HIV) acquisition among women using hormonal contraception and intrauterine devices (IUDs) (2). After careful review, CDC adopted WHO's 2019 updated guidance for inclusion in the U.S. MEC guidance; CDC's updated guidance states that progestin-only injectable contraception (including depot medroxyprogesterone acetate [DMPA]) and IUDs (including levonorgestrel-releasing and copper-bearing) are safe for use without restriction among women at high risk for HIV infection (U.S. MEC category 1 [previously U.S. MEC category 2, advantages outweigh risks]) (Box). CDC's guidance also adds an accompanying clarification for women who wish to use IUDs, which states "Many women at a high risk for HIV infection are also at risk for other sexually transmitted diseases (STDs). For these women, refer to the recommendations in the 'U.S. Medical Eligibility Criteria for Contraceptive Use' for women with other factors related to STDs, and the 'U.S. Selected Practice Recommendations for Contraceptive Use' on STD screening before IUD insertion" (1,3). Recommendations for other hormonal contraceptive methods (including combined hormonal methods, implants, and progestin-only pills) remain the same; there is also no restriction for their use among women at high risk for HIV infection (U.S. MEC category 1). Finally, CDC clarified that the U.S. MEC recommendations for concurrent use of hormonal contraceptives or IUDs and antiretroviral use for treatment of HIV infection also apply to use of antiretrovirals for prevention of HIV acquisition (preexposure prophylaxis [PrEP]).