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Contraceptive Care Made Easy
Abstract & Commentary
By Alison Edelman, MD, MPH, Associate Professor, Assistant Director of the Family Planning Fellowship Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, is Associate Editor for OB/GYN Clinical Alert.
Dr. Edelman reports no financial relationship to this field of study.
Synopsis: The U.S. Medical Eligibility Criteria for Contraceptive Use is a newly released resource by the CDC to aid clinicians in the contraceptive care of women with comorbidities.
Source: CDC. U.S. Medical Eligibility Criteria for Contraceptive Use. MMWR 2010;59:RR-4. Available at: www.cdc.gov/mmwr/pdf/rr/rr5904.pdf.
The U.S. medical eligibility criteria for contraceptive Use is a newly available, free, evidence-based resource for clinicians. This resource provides guidance to aid contraceptive decision-making for women (and men) with comorbidities. These guidelines were adapted and updated specifically for the United States from those initially developed by the World Health Organization (WHOMEC).1 Among the more than 60 medical conditions addressed, rheumatoid arthritis, bariatric surgery, peripartum cardiomyopathy, endometrial hyperplasia, inflammatory bowel disease, and solid organ transplantation have been added.
Although family planning is essential for all women, it is critically important for those women with medical conditions. Unfortunately, the contraceptive care of these women is often neglected due to a variety of reasons; one of which may be the discomfort that many of us feel when dealing with an unfamiliar medical problem. Now there is no excuse, the U.S. Medical Eligibility Criteria for Contraceptive Use (USMEC) provides evidence-based guidelines generated by a review of the literature by experts in family planning, OB/GYN, and specialties dealing with each medical disorder. Categories for contraceptive use are divided into 4 categories: 1 = No restriction; 2 = Advantages for use outweigh the risk; 3 = Risk may outweigh the benefits; 4 = Unacceptable risk. In addition, differences in risk for initiation vs continuation of a contraceptive method are addressed. For examples, see Table (below).
|Table. Examples from USMEC.*|
|Condition||Combined Methods||Progestin- only pill||Injection||Implant||Levonorgestrel
|Migraine with aura, any age||4||2||2||2||2||1|
|Inflammatory bowel disease||2/3**||2||2||2||2||1|
|Carrier/chronic viral hepatitis||1||1||1||1||1||1|
* Methods not listed here, but included in the USMED: family planning methods, sterilization, lactational amenorrhea, and barrier methods.
** For women with IBD with no other risk factors for VTE, the benefits of COC/P/R use generally outweight the risks (Category 2). However, for women with IBD with increased risk for VTE (e.g., those with active or extensive disease, surgery, immobilization, corticosteroid use, vitamin deficiencies, fluid depletion), the risks for COC/P/R use generally outweight the benefits (Category 3).
It is important to note that this resource is meant to "guide" care and that there may be certain instances where the guidance is helpful, but needs to be individualized. The USMEC only deals with the contraceptive method risk of each medical condition. It also addresses if a medical condition (or the drug used to treat it) interferes with contraceptive efficacy as opposed to the inherent risk pregnancy confers. In other words, you and your patient may decide that the risk of the contraceptive method outweighs the risk of pregnancy. Or as a team, you may chose a contraceptive method whose efficacy is decreased by her medical condition (or drug) because she is going to combine it with a barrier method. Remember, any contraceptive method prevents more pregnancies than no contraceptive method.
This resource is available in its entirety from the CDC at: http://www.cdc.gov/mmwr/pdf/rr/rr5904.pdf. Also available at www.cdc.gov/reproductivehealth/Unintendedpregnancy/USMEC.htm are several job aids or 2-page summary tables (I highly recommend laminating these for use in the clinic). Coming soon is a USMEC wheel similar to our coveted pregnancy dating wheels. This website has quick links to the WHOMEC as well.1