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Cited by 1,456Reproductive Health and ContraceptionMale Reproductive Health StudiesHIV/AIDS Research and Interventions

U.S. Medical Eligibility Criteria for Contraceptive Use, 2016

Open access
Curtis, Kathryn M., Tepper, Naomi K., Jatlaoui, Tara C., Berry-Bibee, Erin, Horton, Leah G., Zapata, Lauren B., Simmons, Katharine B., Pagano, H. Pamela +2 more·2016·MMWR. Recommendations and Reports
DOI 10.15585/mmwr.rr6503a1
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Abstract

The 2016 U.S. Medical Eligibility Criteria for Contraceptive Use (U.S. MEC) comprises recommendations for the use of specific contraceptive methods by women and men who have certain characteristics or medical conditions. These recommendations for health care providers were updated by CDC after review of the scientific evidence and consultation with national experts who met in Atlanta, Georgia, during August 26-28, 2015. The information in this report updates the 2010 U.S. MEC (CDC. U.S. medical eligibility criteria for contraceptive use, 2010. MMWR 2010:59 [No. RR-4]). Notable updates include the addition of recommendations for women with cystic fibrosis, women with multiple sclerosis, and women receiving certain psychotropic drugs or St. John's wort; revisions to the recommendations for emergency contraception, including the addition of ulipristal acetate; and revisions to the recommendations for postpartum women; women who are breastfeeding; women with known dyslipidemias, migraine headaches, superficial venous disease, gestational trophoblastic disease, sexually transmitted diseases, and human immunodeficiency virus; and women who are receiving antiretroviral therapy. The recommendations in this report are intended to assist health care providers when they counsel women, men, and couples about contraceptive method choice. Although these recommendations are meant to serve as a source of clinical guidance, health care providers should always consider the individual clinical circumstances of each person seeking family planning services. This report is not intended to be a substitute for professional medical advice for individual patients. Persons should seek advice from their health care providers when considering family planning options.

AI snapshot

Written from a shortened version of the paper’s full text (it is longer than we read).

TL;DR

This 2016 CDC report updates the U.S. Medical Eligibility Criteria for Contraceptive Use (U.S. MEC), assigning category 1–4 classifications for the safety of contraceptive methods in people with specific characteristics and medical conditions. It adds recommendations for cystic fibrosis, multiple sclerosis, certain psychotropic drugs and St. John's wort, and ulipristal acetate for emergency contraception, and revises recommendations for postpartum/breastfeeding women, HIV, and several other conditions.

Key findings

  • Approximately 45% of pregnancies in the United States are unintended; the goal of the recommendations is to remove unnecessary medical barriers to contraception and thereby decrease unintended pregnancies.
  • Eligibility is classified into four categories: 1 = no restriction; 2 = advantages generally outweigh theoretical or proven risks; 3 = risks usually outweigh advantages; 4 = unacceptable health risk. Example given: COCs are category 2 for smokers aged <35 years, category 3 for women aged ≥35 years smoking <15 cigarettes/day, and category 4 for those smoking ≥15 cigarettes/day.
  • Notable updates from U.S. MEC 2010 include new recommendations for women with cystic fibrosis, multiple sclerosis, and women receiving certain psychotropic drugs or St. John's wort; revisions for emergency contraception (adding ulipristal acetate); and revisions for postpartum and breastfeeding women and women with dyslipidemias, migraine, superficial venous disease, gestational trophoblastic disease, STDs, HIV, and those receiving antiretroviral therapy.
  • On progestin-only injectables and HIV acquisition, CDC "reviewed all available evidence and agreed that the data were not sufficiently conclusive to change current guidance," but advises women using these methods to also always use condoms and take other HIV preventive measures.

Methods

  • CDC monitored new literature via the WHO/CDC continuous identification of research evidence (CIRE) system, with automated weekly PubMed searches; in 2014 CDC reviewed all existing 2010 recommendations for evidence that could change a recommendation.
  • An expert meeting was held August 27–28, 2014, in Atlanta with 11 family planning experts and partner representatives to set scope and process; a second meeting August 26–28, 2015, involved 44 participants (29 participating throughout, 15 topic-specific experts).
  • Systematic reviews were conducted for each topic following PRISMA guidelines, with strength and quality of evidence assigned using the U.S. Preventive Services Task Force system; when direct evidence was limited, indirect evidence and theoretical concerns were considered. Reviews were peer reviewed by two or three experts, and three external reviewers commented on accuracy, feasibility, and clarity.

Limitations

  • Stated: recommendations for which no evidence is cited are based on expert opinion from the WHO or U.S. expert meetings and might draw on sources other than systematic reviews; indirect evidence and theoretical concerns were used when direct evidence was limited or unavailable.
  • Stated: limited information exists on the safety of the combined hormonal patch and vaginal ring in women with specific medical conditions, so their categories are considered "a preliminary best judgement" pending further studies, and COC evidence is applied to them except where noted.
  • Stated: evidence on breastfeeding and progestin-only methods is generally of poor quality, lacks standard definitions of breastfeeding or outcome measures, and has not included premature or ill infants; evidence on the relationship between hormonal contraception and HIV acquisition is described as inconclusive.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.15585/mmwr.rr6503a1

Cites

536 of 537 references verified0 citation errors · 1 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 524 cited sources checked · 0 supported · 0 flagged

  • Findingnone given

    Sole use of barrier methods and behavior-based methods of contraception have relatively higher typical-use rates of failure.

    “sole use of barrier methods for contraception and behavior-based methods of contraception might not be the most appropriate choice because of their relatively higher typical-use rates of failure (Figure).”
    Quote in the paperSubstantial claim
  • Findingnone given

    Higher rates of IUD expulsion occur during the postpartum period.

    “Higher rates of expulsion during the postpartum period should be considered as they relate to effectiveness”
    Quote in the paperSubstantial claim
  • Findingcitation

    No studies directly examined the risk for stroke among women with migraine using LNG-IUDs.

    “No studies directly examined the risk for stroke among women with migraine using LNG-IUDs (97).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [97]

      Not checked in the free run.

  • Findingcitation

    Evidence is inconsistent regarding an association between DMPA and increased risk for HIV acquisition.

    “evidence is inconsistent regarding an association between DMPA and increased risk for HIV acquisition”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [108]

      Not checked in the free run.

  • Findingnone given

    Overall, evidence does not support an association between POC use and progression of HIV.

    “Overall, evidence does not support an association between POC use and progression of HIV.”
    Quote in the paperSubstantial claim
  • May combine two claims. 76
  • Classified as probably not a substantial claim. 51

  • May combine two claims.

    Findingnone given

    Limited direct evidence on an association between POC use and transmission of HIV to noninfected partners, as well as studies measuring genital viral shedding as a proxy for infectivity, have had mixed results.

    “Limited direct evidence on an association between POC use and transmission of HIV to noninfected partners, as well as studies measuring genital viral shedding as a proxy for infectivity, have had mixed results.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    No studies have suggested an increased risk for HIV acquisition with etonogestrel implants although data are limited.

    “no studies have suggested an increased risk for HIV acquisition with etonogestrel implants although data are limited (108).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [108]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    No evidence is available about hormonal contraceptive use among women with hepatocellular adenoma.

    “No evidence is available about hormonal contraceptive use among women with hepatocellular adenoma.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    Evidence is inconsistent about whether combined hormonal contraceptive use affects fracture risk, although three recent studies show no effect.

    “Evidence is inconsistent about whether CHC use affects fracture risk (34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45), although three recent studies show no effect (34,35,45).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [34]

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    • cites [35]

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    • cites [45]

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  • May combine two claims.

    Findingcitation

    Studies with pharmacokinetic and pharmacodynamic outcomes raise concern that St. John's wort might decrease effectiveness of hormonal contraceptives, including increased risk for breakthrough bleeding and ovulation and increased metabolism of estrogen and progestin.

    “Although clinical data are limited, studies with pharmacokinetic and pharmacodynamics outcomes raise concern that St. John's wort might decrease effectiveness of hormonal contraceptives, including increased risk for breakthrough bleeding and ovulation and increased metabolism of estrogen and progestin.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [159]

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Venous thromboembolism rates were significantly different only after 13 weeks postpartum, but the numbers needed to harm were lowest in the first 6 weeks postpartum.

    “Rates were significantly different only after 13 weeks postpartum; however, the numbers needed to harm were lowest in the first 6 weeks postpartum.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [89]

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Risk for pregnancy during the first 21 days postpartum is very low but increases after that point, and ovulation before first menses is common.

    “Risk for pregnancy during the first 21 days postpartum is very low but increases after that point; ovulation before first menses is common (95).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [95]

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  • May combine two claims.

    Findingcitation

    Venous thromboembolism risk is increased during pregnancy and the postpartum period; this risk is most pronounced in the first 3 weeks after delivery, decreasing to near baseline levels by 42 days postpartum.

    “VTE risk is increased during pregnancy and the postpartum period; this risk is most pronounced in the first 3 weeks after delivery, decreasing to near baseline levels by 42 days postpartum (90)(91)(92)(93)(94).”
    Quote in the paperSubstantial claim0 of 5 sources checked
    • cites [90]

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    • cites [91]

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    • cites [92]

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    • cites [93]

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    • cites [94]

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  • May combine two claims.

    Findingcitation

    Limited evidence demonstrated no substantial decrease in effectiveness of oral contraceptives among women who underwent a biliopancreatic diversion, but evidence from pharmacokinetic studies reported conflicting results of oral contraceptive effectiveness among women who underwent a jejunoileal bypass.

    “Limited evidence demonstrated no substantial decrease in effectiveness of oral contraceptives among women who underwent a biliopancreatic diversion; however, evidence from pharmacokinetic studies reported conflicting results of oral contraceptive effectiveness among women who underwent a jejunoileal bypass (128).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [128]

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  • May combine two claims.

    Findingcitation

    One study suggested that among women with varicose veins, the rate of venous thromboembolism and superficial venous thrombosis was higher in oral contraceptive users compared with nonusers, but statistical significance was not reported and the number of events was small.

    “One study suggested that among women with varicose veins, the rate of VTE and superficial venous thrombosis was higher in oral contraceptive users compared with nonusers; however, statistical significance was not reported and the number of events was small (176).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [176]

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Limited indirect evidence from noncomparative studies of women with cardiac disease demonstrated few cases of hypertension and transient ischemic attack in women with cardiac disease using combined oral contraceptives, and no cases of heart failure were reported.

    “Limited indirect evidence from noncomparative studies of women with cardiac disease demonstrated few cases of hypertension and transient ischemic attack in women with cardiac disease using COCs.No cases of heart failure were reported (177).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [177]

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    A small proportion of women regret the decision to be sterilized (1%-26% across different studies), with higher rates of regret reported by women who were younger at sterilization.

    “However, a small proportion of women regret this decision (1%-26% from different studies, with higher rates of regret reported by women who were younger at sterilization) (1,2).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [1]

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    • cites [2]

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  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Findingnone given

    No drug interaction between antiretroviral (ARV) therapy and barrier method use is known.

    “No drug interaction between ARV therapy and barrier method use is known.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Findingnone given

    Toxic shock syndrome has been reported in association with contraceptive sponge and diaphragm use.

    “Toxic shock syndrome has been reported in association with contraceptive sponge and diaphragm use.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Approximately 45% of all pregnancies in the United States are unintended.

    “Approximately 45% of all pregnancies that occur in the United States are unintended (1)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [1]

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Unintended pregnancies are associated with increased risks for adverse maternal and infant health outcomes.

    “with associated increased risks for adverse maternal and infant health outcomes (2)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [2]

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Unintended pregnancies are associated with increased health care costs.

    “and increased health care costs (3)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [3]

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  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationreasoning

    Any potential effect on contraceptive effectiveness is likely to be lower with DMPA than with other POCs because of the higher dose of DMPA.

    “Any potential effect on contraceptive effectiveness is likely to be lower with DMPA than with other POCs because of the higher dose of DMPA.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    Concern exists that interactions between NFV and POCs might decrease NFV levels.

    “Concern exists that interactions between NFV and POCs might decrease NFV levels.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationnone given

    Insertion of IUDs among postpartum women is safe and does not appear to increase health risks associated with IUD use such as infection.

    “IUDs: Insertion of IUDs among postpartum women is safe and does not appear to increase health risks associated with IUD use such as infection.”
    • Also stated in: § BOX B1. Categories for classifying intrauterine devices · hedged
      “Clarification: Insertion of IUDs among postpartum women is safe and does not appear to increase health risks associated with IUD use such as infection.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    According to CDC STD treatment guidelines, routine presumptive treatment of chlamydia, gonorrhea, and trichomonas is recommended after sexual assault.

    “According to CDC STD treatment guidelines, routine presumptive treatment of chlamydia, gonorrhea, and trichomonas is recommended after sexual assault (2).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [2]

      Not checked in the free run.

  • May combine two claims.

    Premisenone given

    Evidence for infection, perforation, and removals for pain or bleeding are limited; however, these events are rare.

    “Evidence for infection, perforation, and removals for pain or bleeding are limited; however, these events are rare .”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    The risk for perforation is increased independently among breastfeeding women and among women ≤36 weeks postpartum, compared with non-postpartum women; however, the absolute risk for perforation remains low.

    “The risk for perforation is increased independently among breastfeeding women and among women ≤36 weeks postpartum, compared with non-postpartum women; however, the absolute risk for perforation remains low 65).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [65]

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductnone given

    When direct evidence was limited or not available, indirect evidence and theoretical issues were considered and either added to direct evidence within a systematic review or separately compiled for presentation to the meeting participants.

    “When direct evidence was limited or not available, indirect evidence (e.g., evidence on surrogate outcomes or among healthy women) and theoretical issues were considered and either added to direct evidence within a systematic review or separately compiled for presentation to the meeting participants.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    PRISMA guidelines were followed for reporting systematic reviews, and strength and quality of the evidence were assigned using the U.S. Preventive Services Task Force system.

    “Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed for reporting systematic reviews (8,9), and strength and quality of the evidence were assigned using the system of the U.S. Preventive Services Task Force (10).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [8]

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    • cites [9]

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    • cites [10]

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    UPA is excreted in breast milk with highest concentrations in the first 24 hours, and maximum maternal serum levels are reached 1-3 hours after administration.

    “UPA: Breastfeeding is not recommended for 24 hours after taking UPA because it is excreted in breast milk with highest concentrations in the first 24 hours, and maximum maternal serum levels are reached 1-3 hours after administration.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Premisenone given

    Although ECPs are not indicated for a woman with a known or suspected pregnancy, no harm to the woman, the course of her pregnancy, or the fetus if ECPs are inadvertently used is known to exist.

    “ECPs: Although this method is not indicated for a woman with a known or suspected pregnancy, no harm to the woman, the course of her pregnancy, or the fetus if ECPs are inadvertently used is known to exist.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Premisenone given

    The drug interaction likely involves CYP3A4 pathways; POCs have less effect on CYP3A4 enzymes than CHCs.

    “The drug interaction likely involves CYP3A4 pathways; POCs have less effect on CYP3A4 enzymes than CHCs.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Premisenone given

    Persons with cystic fibrosis are at increased risk for diabetes, liver disease, gallbladder disease, and VTE (particularly related to use of central venous catheters) and are frequently prescribed antibiotics.

    “Persons with cystic fibrosis are at increased risk for diabetes, liver disease, gallbladder disease, and VTE (particularly related to use of central venous catheters) and are frequently prescribed antibiotics.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Initiation of LNG-IUDs at 4 weeks postpartum or later demonstrated no detrimental effect on breastfeeding outcomes and no harmful effect on infant health, growth, or development.

    “Evidence (breastfeeding): Initiation of LNG-IUDs at 4 weeks postpartum or later demonstrated no detrimental effect on breastfeeding outcomes and no harmful effect on infant health, growth, or development (63,64).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [63]

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    • cites [64]

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  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Premisenone given

    No known interaction exists between ARV therapy and IUD use.

    “IUD: No known interaction exists between ARV therapy and IUD use.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    Theoretically, drug interactions might occur between certain ritonavir-boosted protease inhibitors and certain hormonal contraceptives that might reduce the effectiveness of the hormonal contraceptive.

    “Implants, DMPA, POP: Theoretically, drug interactions might occur between certain ritonavir-boosted protease inhibitors and certain hormonal contraceptives that might reduce the effectiveness of the hormonal contraceptive.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    Theoretical concern exists that increased levels of ethinyl estradiol because of interactions with ATV might increase the risk for adverse events.

    “CHCs: Theoretical concern exists that increased levels of ethinyl estradiol because of interactions with ATV might increase the risk for adverse events.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisenone given

    Although immediate postplacental placement at the time of cesarean delivery might have increased risk for expulsion compared with interval placement, risk appears lower than that for placement at the time of vaginal delivery.

    “Although immediate postplacental placement at the time of cesarean delivery might have increased risk for expulsion compared with interval placement, risk appears lower than that for placement at the time of vaginal delivery.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisenone given

    Despite reduced effectiveness among women with BMI ≥30 kg/m2, no safety concerns exist for ECPs.

    “Despite this, no safety concerns exist.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Completed systematic reviews were peer reviewed by two or three experts and then provided to participants before the expert meeting.

    “Completed systematic reviews were peer reviewed by two or three experts and then provided to participants before the expert meeting.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Feedback was received from three external reviewers, composed of health care providers and researchers who had not participated in the update meetings.

    “Feedback also was received from three external reviewers, composed of health care providers and researchers who had not participated in the update meetings.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Premisenone given

    Use of female condoms can provide protection from transmission of STDs, although data are limited.

    “Use of female condoms can provide protection from transmission of STDs, although data are limited.”
    • Also stated in: § Additional information · plain
      “Use of female condoms can provide protection from transmission of STDs, although data are limited.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisenone given

    Evidence suggests drug interactions between certain protease inhibitors and certain hormonal contraceptives, and these interactions might reduce the effectiveness of the hormonal contraceptive.

    “CHCs: Evidence suggests drug interactions between certain protease inhibitors and certain hormonal contraceptives.These interactions might reduce the effectiveness of the hormonal contraceptive.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisenone given

    Evidence suggests drug interactions between efavirenz and certain hormonal contraceptives, and these interactions might reduce the effectiveness of the hormonal contraceptive.

    “Implants, DMPA, POP, CHCs: Evidence suggests drug interactions between efavirenz and certain hormonal contraceptives.These interactions might reduce the effectiveness of the hormonal contraceptive.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Data conflict about whether IUD use is associated with infertility among nulliparous women, although well-conducted studies suggest no increased risk.

    “Evidence: Data conflict about whether IUD use is associated with infertility among nulliparous women, although well-conducted studies suggest no increased risk (1-9).”
    Quote in the paperSubstantial claim0 of 9 sources checked
    • cites [1]

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    • cites [2]

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    • cites [7]

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    • cites [8]

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    • cites [9]

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  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    Theoretical concern exists that postpartum insertion of an IUD in a woman with recent chorioamnionitis or current endometritis might be associated with increased complications.

    “Comment: Theoretical concern exists that postpartum insertion of an IUD in a women with recent chorioamnionitis or current endometritis might be associated with increased complications.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    Theoretical concern exists about the effect of LNG on lipids.

    “Comment: Theoretical concern exists about the effect of LNG on lipids.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Interpretationnone given

    IUD insertion might induce cardiac arrhythmias in healthy women; women with peripartum cardiomyopathy have a high incidence of cardiac arrhythmias.

    “Comment: IUD insertion might induce cardiac arrhythmias in healthy women; women with peripartum cardiomyopathy have a high incidence of cardiac arrhythmias.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Evidence from studies examining the treatment effects of the LNG-IUD among women with heavy or prolonged bleeding reported no increase in adverse effects and found the LNG-IUD to be beneficial in treating menorrhagia.

    “Evidence from studies examining the treatment effects of the LNG-IUD among women with heavy or prolonged bleeding reported no increase in adverse effects and found the LNG-IUD to be beneficial in treating menorrhagia (100-107).”
    Quote in the paperSubstantial claim0 of 8 sources checked
    • cites [100]

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    • cites [101]

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    • cites [102]

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    • cites [103]

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    • cites [104]

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    • cites [105]

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    • cites [106]

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    • cites [107]

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  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    When multiple risk factors for cardiovascular disease exist, risk for cardiovascular disease might increase substantially.

    “When multiple risk factors do exist, risk for cardiovascular disease might increase substantially.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    According to the American Heart Association, administration of prophylactic antibiotics solely to prevent endocarditis is not recommended for patients who undergo genitourinary tract procedures, including insertion or removal of IUDs.

    “Comment: According to the American Heart Association, administration of prophylactic antibiotics solely to prevent endocarditis is not recommended for patients who undergo genitourinary tract procedures, including insertion or removal of IUDs (74).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [74]

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  • May combine two claims.

    Premisecitation

    Although findings on the risk for venous thrombosis with the use of POCs in otherwise healthy women are inconsistent, any small increased risk is substantially less than that with COCs.

    “Although findings on the risk for venous thrombosis with the use of POCs in otherwise healthy women are inconsistent, any small increased risk is substantially less than that with COCs (67-69).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [67]

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    • cites [68]

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    • cites [69]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S4 (based).

    Premisenone given

    A single reading of blood pressure level is not sufficient to classify a woman as hypertensive.

    “A single reading of blood pressure level is not sufficient to classify a woman as hypertensive.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    Insertion of an IUD might substantially worsen the condition in women with immediate postseptic abortion.

    “Comment: Insertion of an IUD might substantially worsen the condition.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation

    The LNG-IUD might be a useful treatment for menorrhagia in women receiving long-term anticoagulation therapy.

    “Comment: The LNG-IUD might be a useful treatment for menorrhagia in women receiving long-term anticoagulation therapy.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Among women with endometrial hyperplasia, no adverse health events occurred with LNG-IUD use; most women experienced disease regression.

    “Among women with endometrial hyperplasia, no adverse health events occurred with LNG-IUD use; most women experienced disease regression (114).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [114]

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    IUD use did not adversely affect progression of HIV during 6-45 months of follow-up or when compared with hormonal contraceptive use among HIV-infected women.

    “IUD use did not adversely affect progression of HIV during 6-45 months of follow-up or when compared with hormonal contraceptive use among HIV-infected women.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [137]

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Among women who had an IUD inserted, the absolute risk for subsequent PID was low among women with STD at the time of insertion but greater than among women with no STD at the time of IUD insertion.

    “Among women who had an IUD inserted, the absolute risk for subsequent PID was low among women with STD at the time of insertion but greater than among women with no STD at the time of IUD insertion (117-123).”
    Quote in the paperSubstantial claim0 of 7 sources checked
    • cites [117]

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    • cites [118]

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    • cites [119]

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    • cites [120]

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    • cites [121]

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    • cites [122]

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    • cites [123]

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  • May combine two claims.

    Premisecitation

    LNG-IUD use among women with endometriosis decreased dysmenorrhea, pelvic pain, and dyspareunia.

    “LNG-IUD use among women with endometriosis decreased dysmenorrhea, pelvic pain, and dyspareunia (108-112).”
    Quote in the paperSubstantial claim0 of 5 sources checked
    • cites [108]

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    • cites [109]

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    • cites [110]

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    • cites [111]

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    • cites [112]

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  • May combine two claims.

    Premisecitation

    Rates of LNG-IUD expulsion were higher in women with uterine fibroids (11%) than in women without fibroids (0%-3%); these findings were either not statistically significant or significance testing was not conducted.

    “Rates of LNG-IUD expulsion were higher in women with uterine fibroids (11%) than in women without fibroids (0%-3%); these findings were either not statistically significant or significance testing was not conducted (115).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [115]

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    IUD use among HIV-infected women was not associated with increased risk for transmission to sex partners or with increased genital viral shedding.

    “Furthermore, IUD use among HIV-infected women was not associated with increased risk for transmission to sex partners or with increased genital viral shedding (137).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [137]

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Among IUD users, limited evidence shows a low risk for PID among HIV-infected women using IUDs and no higher risk for pelvic infectious complications in HIV-infected than in HIV-noninfected women or among women with varying degrees of HIV severity.

    “Among IUD users, limited evidence shows a low risk for PID among HIV-infected women using IUDs and no higher risk for pelvic infectious complications in HIV-infected than in HIV-noninfected women or among women with varying degrees of HIV severity.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [137]

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Most studies have found that women lose BMD during DMPA use but recover BMD after discontinuation.

    “Most studies have found that women lose BMD during DMPA use but recover BMD after discontinuation.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites 1-48

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Although two case reports described three women with IBD who experienced exacerbation of disease 5 days-25 months after LNG-IUD insertion, no comparative studies have examined the safety of IUD use among women with IBD.

    “Although two case reports described three women with IBD who experienced exacerbation of disease 5 days-25 months after LNG-IUD insertion, no comparative studies have examined the safety of IUD use among women with IBD (140).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [140]

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  • May combine two claims.

    Premisecitation

    Evidence is mixed for adolescent DMPA users, with some studies observing greater weight gain among obese compared with normal weight users but other studies showing no association; methodologic differences across studies might account for the differences in findings.

    “Evidence is mixed for adolescent DMPA users, with some studies observing greater weight gain among obese compared with normal weight users but other studies showing no association; methodologic differences across studies might account for the differences in findings.”
    Quote in the paperSubstantial claim0 of 10 sources checked
    • cites [56]

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    • cites [57]

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    • cites [58]

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    • cites [59]

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    • cites [60]

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    • cites [61]

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    • cites [62]

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    • cites [63]

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    • cites [64]

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    • cites [65]

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  • May combine two claims.

    Study design and conductcitation

    In general, these studies are of poor quality, lack standard definitions of breastfeeding or outcome measures, and have not included premature or ill infants.

    “In general, these studies are of poor quality, lack standard definitions of breastfeeding or outcome measures, and have not included premature or ill infants (50,51).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [50]

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    • cites [51]

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  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    CDC reviewed all available evidence and agreed that the data were not sufficiently conclusive to change current guidance.

    “CDC reviewed all available evidence and agreed that the data were not sufficiently conclusive to change current guidance.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Limited evidence demonstrated no substantial decrease in effectiveness of oral contraceptives among women who underwent a biliopancreatic diversion; however, evidence from pharmacokinetic studies suggested conflicting results regarding oral contraceptive effectiveness among women who underwent a jejunoileal bypass.

    “Limited evidence demonstrated no substantial decrease in effectiveness of oral contraceptives among women who underwent a biliopancreatic diversion; however, evidence from pharmacokinetic studies suggested conflicting results regarding oral contraceptive effectiveness among women who underwent a jejunoileal bypass (74).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [74]

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Some studies suggest that women using progestin-only injectable contraception might be at increased risk for HIV acquisition; other studies do not show this association.

    “Some studies suggest that women using progestin-only injectable contraception might be at increased risk for HIV acquisition; other studies do not show this association.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [108]

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Although findings on the risk for venous thrombosis with use of POCs in otherwise healthy women is inconsistent, any small increased risk is substantially less than that with COCs.

    “Although findings on the risk for venous thrombosis with use of POCs in otherwise healthy women is inconsistent, any small increased risk is substantially less than that with COCs (75-77).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [75]

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    • cites [76]

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    • cites [77]

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  • May combine two claims.

    Interpretationreasoning

    Bariatric surgical procedures involving a malabsorptive component have the potential to decrease oral contraceptive effectiveness, perhaps further decreased by postoperative complications such as long-term diarrhea, vomiting, or both.

    “Bariatric surgical procedures involving a malabsorptive component have the potential to decrease oral contraceptive effectiveness, perhaps further decreased by postoperative complications such as long-term diarrhea, vomiting, or both.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Another study found that etonogestrel levels were decreased and 5% of women had presumptive ovulation while using etonogestrel implants with EFV.

    “another study found that etonogestrel levels were decreased and 5% of women had presumptive ovulation while using etonogestrel implants with EFV (140,141).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [140]

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    • cites [141]

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  • May combine two claims.

    Premisecitation

    Three studies of women using LNG implants showed increased pregnancy rates for women using EFV-containing ARV therapy compared with no ARV use, although absolute pregnancy rates were still lower than for other hormonal methods in one study.

    “Three studies of women using LNG implants showed increased pregnancy rates for women using EFV-containing ARV therapy compared with no ARV use, although absolute pregnancy rates were still lower than for other hormonal methods in one study (141-143);”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [141]

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    • cites [142]

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    • cites [143]

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  • May combine two claims.

    Premisecitation

    Among women with sickle cell disease, POC use did not have adverse effects on hematologic parameters and, in some studies, was beneficial with respect to clinical symptoms.

    “Among women with sickle cell disease, POC use did not have adverse effects on hematologic parameters and, in some studies, was beneficial with respect to clinical symptoms (126-133).”
    Quote in the paperSubstantial claim0 of 8 sources checked
    • cites [126]

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    • cites [127]

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    • cites [128]

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    • cites [129]

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    • cites [130]

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    • cites [131]

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    • cites [132]

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    • cites [133]

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  • May combine two claims.

    Premisecitation

    No significant effects were found on pregnancy rates, DMPA levels, EFV levels, or HIV disease progression in women using DMPA and EFV compared with DMPA alone.

    “No significant effects were found on pregnancy rates, DMPA levels, EFV levels, or HIV disease progression in women using DMPA and EFV compared with DMPA alone (141,144-148).”
    Quote in the paperSubstantial claim0 of 6 sources checked
    • cites [141]

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    • cites [144]

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    • cites [145]

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    • cites [146]

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    • cites [147]

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    • cites [148]

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  • May combine two claims.

    Premisecitation

    One study found that women using etonogestrel implants with EFV had a higher pregnancy rate than women not using ARVs, although confidence intervals overlapped and absolute pregnancy rates were still lower than for other hormonal methods.

    “One study found that women using etonogestrel implants with EFV had a higher pregnancy rate than women not using ARVs, although confidence intervals overlapped and absolute pregnancy rates were still lower than for other hormonal methods;”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [140]

      Not checked in the free run.

    • cites [141]

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  • May combine two claims.

    Premisecitation

    One study demonstrated no pregnancies, no ovulations, no change in LPV/r level, and no change in HIV disease progression in women using DMPA.

    “One study demonstrated no pregnancies, no ovulations, no change in LPV/r level, and no change in HIV disease progression in women using DMPA (153);”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [153]

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  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationreasoning

    Although no data exist, POC users with adequately controlled and monitored hypertension should be at lower risk for acute myocardial infarction and stroke than are untreated hypertensive POC users.

    “Although no data exist, POC users with adequately controlled and monitored hypertension should be at lower risk for acute myocardial infarction and stroke than are untreated hypertensive POC users.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Women adequately treated for hypertension are at lower risk for acute myocardial infarction and stroke than are untreated women.

  • May combine two claims.

    Premisecitation

    One study found no pregnancies, no ovulations, no change in DMPA concentrations and no change in HIV disease progression with use of DMPA and NFV compared with DMPA alone.

    “One study found no pregnancies, no ovulations, no change in DMPA concentrations and no change in HIV disease progression with use of DMPA and NFV compared with DMPA alone;”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [145]

      Not checked in the free run.

    • cites [147]

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Another study found a small increase in pregnancy rate in women using DMPA with LPV/r compared with no ARV therapy, however confidence intervals overlapped.

    “another study found a small increase in pregnancy rate in women using DMPA with LPV/r compared with no ARV therapy, however confidence intervals overlapped (141).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [141]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    Drugs that are inhibitors of CYP3A4 or CYP2C9 theoretically have the potential to increase levels of contraceptive steroid, which might increase adverse events.

    “Drugs that are inhibitors of CYP3A4 or CYP2C9 theoretically have the potential to increase levels of contraceptive steroid, which might increase adverse events.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    Combined hormonal contraceptives protect against pregnancy in general, including ectopic gestation.

    “CHCs protect against pregnancy in general, including ectopic gestation.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The risk for future ectopic pregnancy is increased among women who have had an ectopic pregnancy in the past.

  • May combine two claims.

    Premisecitation

    Bone mineral density is a surrogate marker for fracture risk that might not be valid for premenopausal women and therefore might not accurately predict current or future (postmenopausal) fracture risk.

    “BMD is a surrogate marker for fracture risk that might not be valid for premenopausal women and therefore might not accurately predict current or future (postmenopausal) fracture risk (84)(85)(86).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [84]

      Not checked in the free run.

    • cites [85]

      Not checked in the free run.

    • cites [86]

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Bariatric surgical procedures involving a malabsorptive component have the potential to decrease oral contraceptive effectiveness, perhaps further decreased by postoperative complications such as long-term diarrhea or vomiting.

    “Bariatric surgical procedures involving a malabsorptive component have the potential to decrease oral contraceptive effectiveness, perhaps further decreased by postoperative complications, such as long-term diarrhea or vomiting.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationnone given

    Among women with valvular heart disease, combined hormonal contraceptive use may further increase the risk for arterial thrombosis, and women with complicated valvular heart disease are at greatest risk.

    “Among women with valvular heart disease, CHC use may further increase the risk for arterial thrombosis; women with complicated valvular heart disease are at greatest risk.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationnone given

    Combined oral contraceptives might increase fluid retention in healthy women, and fluid retention may worsen heart failure in women with peripartum cardiomyopathy.

    “COCs might increase fluid retention in healthy women; fluid retention may worsen heart failure in women with peripartum cardiomyopathy.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Interpretationnone given

    Combined oral contraceptives might induce cardiac arrhythmias in healthy women, and women with peripartum cardiomyopathy have a high incidence of cardiac arrhythmias.

    “COCs might induce cardiac arrhythmias in healthy women; women with peripartum cardiomyopathy have a high incidence of cardiac arrhythmias.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Women with peripartum cardiomyopathy have a high incidence of cardiac arrhythmias.

  • May combine two claims.

    Premisecitation

    Changes in lipid profile and hemostatic markers were limited, and most changes remained within normal values among women with diabetes using COCs.

    “Changes in lipid profile and hemostatic markers were limited, and most changes remained within normal values (254-263).”
    Quote in the paperSubstantial claim0 of 10 sources checked
    • cites [254]

      Not checked in the free run.

    • cites [255]

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    • cites [256]

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    • cites [257]

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    • cites [258]

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    • cites [259]

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    • cites [260]

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    • cites [261]

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    • cites [262]

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    • cites [263]

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  • May combine two claims.

    Premisecitation

    Women with endometriosis did not report worsening of the condition or any adverse events related to COC use.

    “Women with endometriosis did not report worsening of the condition or any adverse events related to COC use (209).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [209]

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Women with menorrhagia did not report worsening of the condition or any adverse events related to COC use.

    “Women with menorrhagia did not report worsening of the condition or any adverse events related to COC use (208).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [208]

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    One older meta-analysis found that migraine without aura was associated with an increased risk for ischemic stroke, while two more recent meta-analyses did not find such an association.

    “One older meta-analysis found that migraine without aura was associated with an increased risk for ischemic stroke, while two more recent meta-analyses did not find such an association (203-205).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [203]

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    • cites [204]

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    • cites [205]

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  • May combine two claims.

    Premisecitation

    Among women with insulin-dependent or non-insulin-dependent diabetes, COC use had limited effect on daily insulin requirements and no effect on long-term diabetes control (e.g., glycosylated hemoglobin levels) or progression to retinopathy.

    “Among women with insulin-dependent or non-insulin-dependent diabetes, COC use had limited effect on daily insulin requirements and no effect on long-term diabetes control (e.g., glycosylated hemoglobin levels) or progression to retinopathy.”
    Quote in the paperSubstantial claim0 of 10 sources checked
    • cites [254]

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    • cites [255]

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    • cites [256]

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    • cites [257]

      Not checked in the free run.

    • cites [258]

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    • cites [259]

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    • cites [260]

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    • cites [261]

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    • cites [262]

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    • cites [263]

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Routine presumptive treatment of chlamydia, gonorrhea, and trichomonas is recommended after sexual assault.

    “According to CDC STD treatment guidelines, routine presumptive treatment of chlamydia, gonorrhea, and trichomonas is recommended after sexual assault (3).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [3]

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Data suggest that in women with chronic hepatitis, COC use does not increase the rate or severity of cirrhotic fibrosis, nor does it increase the risk for hepatocellular carcinoma.

    “Data suggest that in women with chronic hepatitis, COC use does not increase the rate or severity of cirrhotic fibrosis, nor does it increase the risk for hepatocellular carcinoma.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [265]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Interpretationreasoning

    The duration of ECP use is less than that of regular use of COCs or POPs and thus would be expected to have less clinical impact.

    “The duration of ECP use is less than that of regular use of COCs or POPs and thus would be expected to have less clinical impact.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    UPA is excreted in breast milk, with highest concentrations in the first 24 hours, and maximum maternal serum levels are reached 1-3 hours after administration.

    “Breastfeeding is not recommended for 24 hours after taking UPA because it is excreted in breast milk, with highest concentrations in the first 24 hours, and maximum maternal serum levels are reached 1-3 hours after administration.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [2]

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Two pharmacokinetic studies demonstrated decreased concentrations of ethinyl estradiol and progestin among women using COCs and NVP compared with COCs alone, and one study found no change in contraceptive hormone concentrations.

    “Two pharmacokinetic studies demonstrated decreased concentrations of ethinyl estradiol and progestin among women using COCs and NVP compared with COCs alone, and one study found no change in contraceptive hormone concentrations (278,284,285).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [278]

      Not checked in the free run.

    • cites [284]

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    • cites [285]

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Two studies suggested that pregnancy rates might be higher among women using COCs and EFV compared with COCs alone, although one study found no difference in pregnancy rates.

    “Two studies suggested that pregnancy rates might be higher among women using COCs and EFV compared with COCs alone, although one study found no difference in pregnancy rates (275-277)”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [275]

      Not checked in the free run.

    • cites [276]

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    • cites [277]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationnone given

    Symptoms-based and calendar-based fertility awareness-based methods do not protect against sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV).

    “Symptoms-based and calendarbased methods do not protect against sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV)”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    Female and male sterilization do not protect against sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV).

    “Female and male sterilization do not protect against sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV)”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    Hormonal contraceptives and intrauterine devices do not protect against sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV).

    “Hormonal contraceptives and intrauterine devices do not protect against sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV)”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Repeated and high-dose use of the spermicide nonoxynol-9 was associated with increased risk for genital lesions, which might increase the risk for HIV infection.

    “Repeated and high-dose use of the spermicide nonoxynol-9 was associated with increased risk for genital lesions, which might increase the risk for HIV infection (2).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [2]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    Use of spermicides or diaphragms (with spermicide) can disrupt the cervical mucosa, which might increase viral shedding and HIV transmission to noninfected sex partners.

    “Use of spermicides or diaphragms (with spermicide) can disrupt the cervical mucosa, which might increase viral shedding and HIV transmission to noninfected sex partners.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Interpretationnone given

    Tubal sterilization for women and vasectomy for men are permanent, safe, and highly effective methods of contraception.

    “Tubal sterilization for women and vasectomy for men are permanent, safe, and highly effective methods of contraception.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Premisenone given

    Endometrial cancer is associated with increased risk for adverse health events as a result of pregnancy.

    “Endometrial cancer This condition is associated with increased risk for adverse health events as a result of pregnancy (Box 2).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Obese women might also experience an increased risk for pregnancy after use of UPA compared with nonobese women, although this increase was not significant in one study.

    “Two analyses suggest obese women might also experience an increased risk for pregnancy after use of UPA compared with nonobese women, although this increase was not significant in one study (4).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [4]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    In general, FAB methods can be used without concern for health effects in persons who choose them.

    “In general, FAB methods can be used without concern for health effects in persons who choose them.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    Theoretical concerns extend to use of other CYP3A4 inducers as well as to COC and LNG ECPs, which have metabolic pathways similar to those of UPA.

    “Therefore, theoretical concerns extend to use of other CYP3A4 inducers as well as to COC and LNG ECPs, which have metabolic pathways similar to those of UPA.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    No medical conditions worsen because of fertility awareness-based (FAB) methods.

    “No medical conditions worsen because of FAB methods.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The Bellagio Consensus provided the scientific basis for defining the conditions under which breastfeeding can be used safely and effectively for birth-spacing purposes.

    “The Bellagio Consensus provided the scientific basis for defining the conditions under which breastfeeding can be used safely and effectively for birth-spacing purposes; programmatic guidelines were developed at a meeting of family planning experts for its use as a method of family planning, and the method was then given the name the lactational amenorrhea method (1,2).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [1]

      Not checked in the free run.

    • cites [2]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    Coitus interruptus does not protect against sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV).

    “Coitus interruptus does not protect against sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV)”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    All major medical organizations recommend exclusive breastfeeding for the first 6 months of life, with continuing breastfeeding through the first year and beyond for as long as mutually desired.

    “All major medical organizations recommend exclusive breastfeeding for the first 6 months of life, with continuing breastfeeding through the first year and beyond for as long as mutually desired (3).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [3]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Interpretationnone given

    Coitus interruptus is unforgiving of incorrect use, and its effectiveness depends on the willingness and ability of the couple to use withdrawal with every act of intercourse.

    “Coitus interruptus is unforgiving of incorrect use, and its effectiveness depends on the willingness and ability of the couple to use withdrawal with every act of intercourse.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    The lactational amenorrhea method requires three criteria, all of which must be met to ensure adequate protection from an unplanned pregnancy: amenorrhea; fully or nearly fully breastfeeding (no interval of >4-6 hours between breastfeeds); and <6 months postpartum.

    “These guidelines include the following three criteria, all of which must be met to ensure adequate protection from an unplanned pregnancy: 1) amenorrhea; 2) fully or nearly fully breastfeeding (no interval of >4-6 hours between breastfeeds); and 3) <6 months postpartum.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [1]

      Not checked in the free run.

    • cites [2]

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisenone given

    Consistent and correct use of the male latex condom reduces the risk for transmission of HIV and other STDs.

    “women using these methods should be counseled that consistent and correct use of the male latex condom reduces the risk for transmission of HIV and other STDs.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationnone given

    In general, no medical conditions absolutely restrict a person's eligibility for sterilization, with the exception of known allergy or hypersensitivity to any materials used to complete the sterilization method.

    “In general, no medical conditions absolutely restrict a person's eligibility for sterilization (with the exception of known allergy or hypersensitivity to any materials used to complete the sterilization method).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Interpretationnone given

    Coitus interruptus prevents sperm from entering the woman's vagina, thereby preventing contact between spermatozoa and the ovum.

    “Coitus interruptus prevents sperm from entering the woman's vagina, thereby preventing contact between spermatozoa and the ovum.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Rifampin markedly decreases UPA levels by ≥90%, which might decrease its efficacy.

    “According to labelling information, rifampin markedly decreases UPA levels by ≥90%, which might decrease its efficacy (2).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [2]

      Not checked in the free run.

114 of 114

  • The authors state this as an assumption.

    For all subconditions of gestational trophoblastic disease, women are under close medical supervision because of the need for monitoring of β-hCG levels for appropriate disease surveillance.

    “For all subconditions of gestational trophoblastic disease, classifications are based on the assumption that women are under close medical supervision because of the need for monitoring of β-hCG levels for appropriate disease surveillance.”
    “For all subconditions of gestational trophoblastic disease, classifications are based on the assumption that women are under close medical supervision because of the need for monitoring of β-hCG levels for appropriate disease surveillance.”

  • The paper relies on this without support.

    Superficial venous thrombosis might be associated with an increased risk for VTE.

    “CHCs: Superficial venous thrombosis might be associated with an increased risk for VTE.”

  • The paper relies on this without support.

    Superficial venous thrombosis associated with a peripheral intravenous catheter is less likely to be associated with additional thrombosis.

    “Superficial venous thrombosis associated with a peripheral intravenous catheter is less likely to be associated with additional thrombosis and use of CHCs may be considered.”

  • The paper relies on this without support.

    Most women do not require additional STD screening at the time of IUD insertion.

    “IUD initiation: Most women do not require additional STD screening at the time of IUD insertion.”

  • The paper relies on this without support.

    Breastfeeding provides important health benefits for mother and infant.

    “Breastfeeding provides important health benefits for mother and infant.”

  • The paper relies on this without support.

    Women using teratogenic drugs are at increased risk for poor pregnancy outcomes.

    “women using teratogenic drugs are at increased risk for poor pregnancy outcomes”

  • The paper relies on this without support.

    Hormonal contraceptives and IUDs are highly effective at preventing pregnancy.

    “Although hormonal contraceptives and IUDs are highly effective at preventing pregnancy, they do not protect against STDs, including HIV.”

  • The paper relies on this without support.

    Hormonal contraceptives and IUDs do not protect against STDs, including HIV.

    “Although hormonal contraceptives and IUDs are highly effective at preventing pregnancy, they do not protect against STDs, including HIV.”

  • The paper relies on this without support.

    IUDs do not protect against sexually transmitted diseases, including HIV.

    “IUDs do not protect against sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV), and women using these methods should be counseled that consistent and correct use of the male latex condom reduces the risk for transmission of HIV and other STDs.”

  • The paper relies on this without support.

    Persons with SLE are at increased risk for ischemic heart disease, stroke, and VTE.

    “Clarification: Persons with SLE are at increased risk for ischemic heart disease, stroke, and VTE.”
    “Persons with SLE are at increased risk for ischemic heart disease, stroke, and VTE.”
    “Persons with SLE are at increased risk for ischemic heart disease, stroke, and VTE.”

  • The paper relies on this without support.

    Severe thrombocytopenia increases the risk for bleeding.

    “Clarification: Severe thrombocytopenia increases the risk for bleeding.”
    “Severe thrombocytopenia increases the risk for bleeding.”

  • The authors state this as an assumption.

    For cystic fibrosis, classifications are based on the assumption that no other conditions are present; these classifications must be modified in the presence of such conditions.

    “For cystic fibrosis, classifications are based on the assumption that no other conditions are present; these classifications must be modified in the presence of such conditions.”
    “For cystic fibrosis, classifications are based on the assumption that no other conditions are present; these classifications must be modified in the presence of such conditions.”

  • The authors state this as an assumption.

    For all categories of hypertension, classifications are based on the assumption that no other risk factors for cardiovascular disease exist.

    “For all categories of hypertension, classifications are based on the assumption that no other risk factors for cardiovascular disease exist.”

  • The authors state this as an assumption.

    For all subconditions of SLE, classifications are based on the assumption that no other risk factors for cardiovascular disease are present; these classifications must be modified in the presence of such risk factors.

    “For all subconditions of SLE, classifications are based on the assumption that no other risk factors for cardiovascular disease are present; these classifications must be modified in the presence of such risk factors.”
    “For all subconditions of SLE, classifications are based on the assumption that no other risk factors for cardiovascular disease are present; these classifications must be modified in the presence of such risk factors.”

  • The authors state this as an assumption.

    For all subconditions of SLE, no other risk factors for cardiovascular disease are present.

    “For all subconditions of SLE, classifications are based on the assumption that no other risk factors for cardiovascular disease are present”

  • The authors state this as an assumption.

    For cystic fibrosis, no other conditions are present.

    “For cystic fibrosis, classifications are based on the assumption that no other conditions are present”

  • The authors state this as an assumption.

    For all categories of hypertension, no other risk factors exist for cardiovascular disease.

    “For all categories of hypertension, classifications are based on the assumption that no other risk factors exist for cardiovascular disease.”

  • The authors state this as an assumption.

    For all categories of hypertension, classifications are based on the assumption that no other risk factors exist for cardiovascular disease.

    “For all categories of hypertension, classifications are based on the assumption that no other risk factors exist for cardiovascular disease.”

  • The paper relies on this without support.

    When multiple risk factors do exist, risk for cardiovascular disease might increase substantially.

    “When multiple risk factors do exist, risk for cardiovascular disease might increase substantially.”

  • The paper relies on this without support.

    A single reading of blood pressure level is not sufficient to classify a woman as hypertensive.

    “A single reading of blood pressure level is not sufficient to classify a woman as hypertensive.”

  • The paper relies on this without support.

    Women adequately treated for hypertension are at lower risk for acute myocardial infarction and stroke than are untreated women.

    “Women adequately treated for hypertension are at lower risk for acute myocardial infarction and stroke than are untreated women.”

  • The paper relies on this without support.

    Irregular menstrual bleeding patterns are common among healthy women.

    “Irregular menstrual bleeding patterns are common among healthy women.”

  • The paper relies on this without support.

    POC use frequently induces an irregular bleeding pattern.

    “POC use frequently induces an irregular bleeding pattern.”

  • The paper relies on this without support.

    Implant use might induce irregular bleeding patterns, especially during the first 3-6 months, although these patterns might persist longer.

    “Implant use might induce irregular bleeding patterns, especially during the first 3-6 months, although these patterns might persist longer.”

  • The paper relies on this without support.

    Breast cancer is a hormonally sensitive tumor, and the prognosis for women with current or recent breast cancer might worsen with POC use.

    “Breast cancer is a hormonally sensitive tumor, and the prognosis for women with current or recent breast cancer might worsen with POC use.”

  • The paper relies on this without support.

    POCs do not appear to cause growth of uterine fibroids.

    “POCs do not appear to cause growth of uterine fibroids.”

  • The paper relies on this without support.

    POCs do not protect against HIV or lower genital tract STDs.

    “they do not protect against HIV or lower genital tract STDs.”

  • The paper relies on this without support.

    Rifampin is likely to decrease the effectiveness of some POCs.

    “Rifampin is likely to decrease the effectiveness of some POCs.”

  • The paper relies on this without support.

    Some POCs might increase the risk for thrombosis, although this increase is substantially less than with COCs.

    “Some POCs might increase the risk for thrombosis, although this increase is substantially less than with COCs.”

  • The paper relies on this without support.

    Absorption of POPs among women with IBD might be reduced if the woman has substantial malabsorption caused by severe disease or small bowel surgery.

    “Absorption of POPs among women with IBD might be reduced if the woman has substantial malabsorption caused by severe disease or small bowel surgery.”

  • The paper relies on this without support.

    Women with IBD have a higher prevalence of osteoporosis and osteopenia than the general population.

    “Women with IBD have a higher prevalence of osteoporosis and osteopenia than the general population.”

  • The paper relies on this without support.

    COC use in healthy women is associated with development and growth of hepatocellular adenoma.

    “COC use in healthy women is associated with development and growth of hepatocellular adenoma; whether other hormonal contraceptives have similar effects is not known.”

  • The paper relies on this without support.

    Women with cystic fibrosis have a higher prevalence of osteopenia, osteoporosis, and fragility fractures than the general population.

    “Women with cystic fibrosis have a higher prevalence of osteopenia, osteoporosis, and fragility fractures than the general population.”

  • The paper relies on this without support.

    Changes in the menstrual pattern associated with POC use have little effect on hemoglobin levels.

    “Changes in the menstrual pattern associated with POC use have little effect on hemoglobin levels.”

  • The paper relies on this without support.

    Progestin-only implants might induce cardiac arrhythmias in healthy women.

    “Progestin-only implants might induce cardiac arrhythmias in healthy women”

  • The paper relies on this without support.

    Women with peripartum cardiomyopathy have a high incidence of cardiac arrhythmias.

    “women with peripartum cardiomyopathy have a high incidence of cardiac arrhythmias.”
    “women with peripartum cardiomyopathy have a high incidence of cardiac arrhythmias.”

  • The authors state this as an assumption.

    For all subconditions of gestational trophoblastic disease, classifications are based on the assumption that women are under close medical supervision because of the need for monitoring of β-hCG levels for appropriate disease surveillance.

    “For all subconditions of gestational trophoblastic disease, classifications are based on the assumption that women are under close medical supervision because of the need for monitoring of β-hCG levels for appropriate disease surveillance.”

  • The paper relies on this without support.

    The risk for future ectopic pregnancy is increased among women who have had an ectopic pregnancy in the past.

    “The risk for future ectopic pregnancy is increased among women who have had an ectopic pregnancy in the past.”

  • The paper relies on this without support.

    Persons with systemic lupus erythematosus are at increased risk for ischemic heart disease, stroke, and venous thromboembolism.

    “Persons with SLE are at increased risk for ischemic heart disease, stroke, and VTE.”

  • The paper relies on this without support.

    Some conditions that increase the risk for deep venous thrombosis or pulmonary embolism are heritable.

    “Some conditions that increase the risk for DTV/PE are heritable.”

  • The paper relies on this without support.

    Women adequately treated for hypertension are at reduced risk for acute myocardial infarction and stroke compared with untreated women.

    “Women adequately treated for hypertension are at reduced risk for acute myocardial infarction and stroke compared with untreated women.”

  • The paper relies on this without support.

    Fluvoxamine is a selective serotonin reuptake inhibitor known to be a moderate inhibitor of both CYP3A4 and CYP2C9.

    “Fluvoxamine is an SSRI known to be a moderate inhibitor of both 3A4 and 2C9; however, no clinical or pharmacokinetic studies were identified to explore potential drug-drug interactions.”

  • The paper relies on this without support.

    Among women with migraine, oral contraceptive use is associated with about a threefold increased risk for ischemic stroke compared with nonuse.

    “Among women with migraine, oral contraceptive use is associated with about a threefold increased risk for ischemic stroke compared with nonuse, although most studies did not specify migraine type or oral contraceptive formulation.”

  • The paper relies on this without support.

    No conditions that cause vaginal bleeding will be worsened in the short-term by use of CHCs.

    “No conditions that cause vaginal bleeding will be worsened in the short-term by use of CHCs.”

  • The paper relies on this without support.

    COC use reduces the risk for endometrial cancer; whether patch or ring use reduces the risk for endometrial cancer is not known.

    “COC use reduces the risk for endometrial cancer; whether patch or ring use reduces the risk for endometrial cancer is not known.”

  • The paper relies on this without support.

    COC use reduces the risk for ovarian cancer; whether patch or ring use reduces the risk for ovarian cancer is not known.

    “COC use reduces the risk for ovarian cancer; whether patch or ring use reduces the risk for ovarian cancer is not known.”

  • The paper relies on this without support.

    COCs do not appear to cause growth of uterine fibroids, and patch and ring also are not expected to cause growth.

    “COCs do not appear to cause growth of uterine fibroids, and patch and ring also are not expected to cause growth.”

  • The paper relies on this without support.

    COCs might reduce the risk for PID among women with STDs but do not protect against HIV or lower genital tract STDs.

    “COCs might reduce the risk for PID among women with STDs but do not protect against HIV or lower genital tract STDs.”

  • The paper relies on this without support.

    Overall, evidence does not support an association between COC use and progression of HIV.

    “Overall, evidence does not support an association between COC use and progression of HIV.”

  • The paper relies on this without support.

    Limited direct evidence does not support an association between COC use and transmission of HIV to noninfected partners; studies measuring genital viral shedding as a proxy for infectivity have had mixed results.

    “Limited direct evidence does not support an association between COC use and transmission of HIV to noninfected partners; studies measuring genital viral shedding as a proxy for infectivity have had mixed results.”

  • The paper relies on this without support.

    CHCs might cause a small increased risk for gallbladder disease.

    “CHCs might cause a small increased risk for gallbladder disease.”

  • The paper relies on this without support.

    CHCs might worsen existing gallbladder disease.

    “CHCs might worsen existing gallbladder disease.”

  • The paper relies on this without support.

    History of pregnancy-related cholestasis might predict an increased risk for COC-related cholestasis.

    “History of pregnancy-related cholestasis might predict an increased risk for COC-related cholestasis.”

  • The paper relies on this without support.

    History of COC-related cholestasis predicts an increased risk with subsequent COC use.

    “History of COC-related cholestasis predicts an increased risk with subsequent COC use.”

  • The paper relies on this without support.

    Anecdotal evidence from countries where thalassemia is prevalent indicates that COC use does not worsen the condition.

    “Anecdotal evidence from countries where thalassemia is prevalent indicates that COC use does not worsen the condition.”

  • The paper relies on this without support.

    CHC use might decrease menstrual blood loss.

    “CHC use might decrease menstrual blood loss.”

  • The paper relies on this without support.

    Limited clinical and pharmacokinetic data do not demonstrate concern for SSRIs decreasing the effectiveness of oral contraceptives.

    “Limited clinical and pharmacokinetic data do not demonstrate concern for SSRIs decreasing the effectiveness of oral contraceptives.”

  • The paper relies on this without support.

    Women with multiple sclerosis are at higher risk than unaffected women for VTE.

    “However, women with multiple sclerosis are at higher risk than unaffected women for VTE.”

  • The paper relies on this without support.

    Women with breast cancer susceptibility genes (e.g., BRCA1 and BRCA2) have a higher baseline risk for breast cancer than women without these genes.

    “Women with breast cancer susceptibility genes (e.g., BRCA1 and BRCA2) have a higher baseline risk for breast cancer than women without these genes.”

  • The paper relies on this without support.

    The baseline risk for breast cancer is also higher among women with a family history of breast cancer than among those who do not have such a history.

    “The baseline risk for breast cancer is also higher among women with a family history of breast cancer than among those who do not have such a history.”

  • The paper relies on this without support.

    Menstrual irregularities are common in postmenarche and perimenopause and might complicate the use of FAB methods.

    “Menstrual irregularities are common in postmenarche and perimenopause and might complicate the use of FAB methods.”

  • The paper relies on this without support.

    Women who are primarily breastfeeding and are amenorrheic are unlikely to have sufficient ovarian function to produce detectable fertility signs and hormonal changes during the first 6 months postpartum.

    “Women who are primarily breastfeeding and are amenorrheic are unlikely to have sufficient ovarian function to produce detectable fertility signs and hormonal changes during the first 6 months postpartum.”

  • The paper relies on this without support.

    The likelihood of resumption of fertility increases with time postpartum and with substitution of breast milk by other foods.

    “However, the likelihood of resumption of fertility increases with time postpartum and with substitution of breast milk by other foods.”

  • The paper relies on this without support.

    Nonbreastfeeding women are not likely to have detectable fertility signs or hormonal changes before 4 weeks postpartum.

    “Nonbreastfeeding women are not likely to have detectable fertility signs or hormonal changes before 4 weeks postpartum.”

  • The paper relies on this without support.

    Ovulation before first menses is common in nonbreastfeeding postpartum women.

    “Although the risk for pregnancy is low, ovulation before first menses is common; therefore, a method appropriate for the postpartum period should be offered.”

  • The paper relies on this without support.

    Nonbreastfeeding women are likely to have sufficient ovarian function to produce detectable fertility signs, hormonal changes, or both at this time; likelihood increases rapidly with time postpartum.

    “Nonbreastfeeding women are likely to have sufficient ovarian function to produce detectable fertility signs, hormonal changes, or both at this time; likelihood increases rapidly with time postpartum.”

  • The paper relies on this without support.

    After abortion, women are likely to have sufficient ovarian function to produce detectable fertility signs, hormonal changes, or both; likelihood increases with time postabortion.

    “After abortion, women are likely to have sufficient ovarian function to produce detectable fertility signs, hormonal changes, or both; likelihood increases with time postabortion.”

  • The paper relies on this without support.

    Presence of irregular vaginal bleeding makes FAB methods unreliable.

    “Presence of this condition makes FAB methods unreliable.”

  • The paper relies on this without support.

    Vaginal discharge makes recognition of cervical secretions difficult.

    “Because vaginal discharge makes recognition of cervical secretions difficult, the condition should be evaluated and treated if needed before providing methods based on cervical secretions.”

  • The paper relies on this without support.

    Use of certain mood-altering drugs such as lithium, tricyclic antidepressants, and antianxiety therapies, as well as certain antibiotics and anti-inflammatory drugs, might alter cycle regularity or affect fertility signs.

    “Use of certain mood-altering drugs such as lithium, tricyclic antidepressants, and antianxiety therapies, as well as certain antibiotics and anti-inflammatory drugs, might alter cycle regularity or affect fertility signs.”

  • The paper relies on this without support.

    Elevated temperatures might make basal body temperature difficult to interpret but have no effect on cervical secretions.

    “Elevated temperatures might make basal body temperature difficult to interpret but have no effect on cervical secretions.”

  • The paper relies on this without support.

    Some chronic diseases interfere with cycle regularity, making calendar-based methods difficult to interpret.

    “In addition, some chronic diseases interfere with cycle regularity, making calendar-based methods difficult to interpret.”

  • The paper relies on this without support.

    Bariatric surgical procedures involving a malabsorptive component have the potential to decrease oral contraceptive effectiveness, perhaps further decreased by postoperative complications such as long-term diarrhea, vomiting, or both.

    “Bariatric surgical procedures involving a malabsorptive component have the potential to decrease oral contraceptive effectiveness, perhaps further decreased by postoperative complications such as long-term diarrhea, vomiting, or both.”

  • The paper relies on this without support.

    Cu-IUDs, UPA, LNG, and COCs do not protect against sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV).

    “Cu-IUDs, UPA, LNG, and COCs do not protect against sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV), and women using these methods should be counseled that consistent and correct use of the male latex condom reduces the risk for transmission of HIV and other STDs.”

  • The paper relies on this without support.

    Consistent and correct use of the male latex condom reduces the risk for transmission of HIV and other STDs.

    “consistent and correct use of the male latex condom reduces the risk for transmission of HIV and other STDs.”

  • The paper relies on this without support.

    Use of female condoms can provide protection from transmission of STDs, although data are limited.

    “Use of female condoms can provide protection from transmission of STDs, although data are limited.”

  • The paper relies on this without support.

    Frequently repeated ECP use might be harmful for women with conditions classified as 2, 3, or 4 for CHC or POC use.

    “Frequently repeated ECP use might be harmful for women with conditions classified as 2, 3, or 4 for CHC or POC use.”

  • The paper relies on this without support.

    Women who have experienced sexual assault are at increased risk for STDs.

    “Women who have experienced sexual assault are at increased risk for STDs.”

  • The paper relies on this without support.

    No safety concerns exist for ECPs in obese women.

    “Despite this, no safety concerns exist.”

  • The paper relies on this without support.

    The risk for cardiovascular disease increases with age and might increase with CHC use.

    “The risk for cardiovascular disease increases with age and might increase with CHC use.”

  • The paper relies on this without support.

    Limited information is available about the safety of the combined hormonal patch and combined vaginal ring among women with specific medical conditions.

    “Limited information is available about the safety of the combined hormonal patch and combined vaginal ring among women with specific medical conditions.”

  • The paper relies on this without support.

    Evidence indicates that the combined hormonal patch and the combined vaginal ring provide comparable safety and pharmacokinetic profiles to COCs with similar hormone formulations.

    “Evidence indicates that the combined hormonal patch and the combined vaginal ring provide comparable safety and pharmacokinetic profiles to COCs with similar hormone formulations .”

  • The paper relies on this without support.

    Risk for cervical cap failure is higher in parous women than in nulliparous women.

    “Risk for cervical cap failure is higher in parous women than in nulliparous women.”

  • The paper relies on this without support.

    Severe obesity might make diaphragm and cap placement difficult.

    “Severe obesity might make diaphragm and cap placement difficult.”

  • The paper relies on this without support.

    Repeated and high-dose use of the spermicide nonoxynol-9 can cause vaginal and cervical irritation or abrasions.

    “Repeated and high-dose use of the spermicide nonoxynol-9 can cause vaginal and cervical irritation or abrasions.”

  • The paper relies on this without support.

    In the United States, replacement feeding is affordable, feasible, acceptable, sustainable, and safe.

    “Therefore, in the United States, where replacement feeding is affordable, feasible, acceptable, sustainable, and safe, breastfeeding for women with HIV is not recommended (3,4).”

  • The paper relies on this without support.

    Fertility awareness-based methods have relatively higher typical-use failure rates.

    “Women with conditions that make pregnancy an unacceptable risk should be advised that FAB methods might not be appropriate for them because of the relatively higher typical-use failure rates of these methods.”

  • The paper relies on this without support.

    The lactational amenorrhea method has relatively higher typical-use failure rates.

    “Women with conditions that make pregnancy an unacceptable risk should be advised that the lactational amenorrhea method might not be appropriate for them because of its relatively higher typical-use failure rates.”

  • The paper relies on this without support.

    Coitus interruptus has relatively higher typical-use failure rates.

    “Women with conditions that make pregnancy an unacceptable risk should be advised that coitus interruptus might not be appropriate for them because of its relatively higher typical-use failure rates.”
89 of 89

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • The 2016 CDC U.S. Medical Eligibility Criteria for Contraceptive Use considered CHC use with any hereditary thrombophilia to be associated with unacceptable health risk (Category 4).

    “In 2016, the Center for Disease Control issued the U.S. Medical Eligibility Criteria for Contraceptive Use, in which CHC use with any hereditary thrombophilia was considered to be associated with unacceptable health risk (Category 4)[112].”

    From Estrogen and thrombosis: a bench to bedside review (2020) · cites this paper as [112]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Diaphragm and cap classified as unrestricted immediately after second-trimester abortion

    Minor

    The postabortion row assigns the diaphragm/cap category 1, meaning no restriction, for second-trimester abortion. Its clarification instead says these methods are unsuitable until six weeks afterward.

  • Cervical cap classified as unrestricted despite instruction not to use it for cervical intraepithelial neoplasia

    Minor

    The barrier-method table assigns the diaphragm/cap category 1, meaning no restriction, for cervical intraepithelial neoplasia. Its clarification says the cap should not be used.

2 of 2

Cites

2 retracted

Flagged first, then by citations

Research works printed but not linked: 63

  1. El-Shafei MM, Mashali A, Hassan EO, El-Boghdad L, El-Lakkany N. Postpartum and postabortion intrauterine device insertion unmet needs of safe reproductive health: three years experience of Mansoura University Hospital. J Egypt Soc Obstet Gynecol 2000;26:253-62.
  2. Puzey M. Mirena at caesarean section. Eur J Contracep Reprod 2005;10:164-7.
  3. Braniff K, Gomez E, Muller R. A randomised clinical trial to assess satisfaction with the levonorgestrel-releasing intrauterine system inserted at caesarean section compared to postpartum placement. Aust N Z J Obstet Gynaecol 2015;55:279-83. http://dx.doi.org/10.1111/ajo.12335 · DOI
  4. Rogovskaya S, Rivera R, Grimes DA, et al. Effect of a levonorgestrel intrauterine system on women with type 1 diabetes: a randomized trial. Obstet Gynecol 2005;105:811-5. http://dx.doi.org/10.1097/01. AOG.0000156301.11939.56 140 · DOI
  5. Phillips SJ, Tepper NK, Kapp N, Nanda K, Temmerman M, Curtis KM. Progestogen-only contraceptive use among breastfeeding women: a systematic review. Contraception 2015;S0010-7824(15)00585-5.
  6. World Health Organization Collaborative Study of Cardiovascular Disease and Steroid Hormone Contraception. Cardiovascular disease and use of oral and injectable progestogen-only contraceptives and combined injectable contraceptives. Results of an international, multicenter, case-control study. Contraception 1998;57:315-24 http:// dx.doi.org/10.1016/S0010-7824(98)00041-9 · DOI
  7. Heinemann LA, Assmann A, DoMinh T, Garbe E. Oral progestogen- only contraceptives and cardiovascular risk: results from the Transnational Study on Oral Contraceptives and the Health of Young Women. Eur J Contracept Reprod Health Care 1999;4:67-73. http://dx.doi. org/10.3109/13625189909064007 · DOI
  8. Vasilakis C, Jick H, del Mar Melero-Montes M. Risk of idiopathic venous thromboembolism in users of progestagens alone. Lancet 1999;354:1610-1. http://dx.doi.org/10.1016/S0140-6736(99)04394-9 · DOI
  9. Tepper NK, Paulen ME, Marchbanks PA, Curtis KM. Safety of contraceptive use among women with peripartum cardiomyopathy: a systematic review. Contraception 2010;82:95-101. http://dx.doi. org/10.1016/j.contraception.2010.02.004 · DOI
  10. Bernatsky S, Clarke A, Ramsey-Goldman R, et al. Hormonal exposures and breast cancer in a sample of women with systemic lupus erythematosus. Rheumatology (Oxford) 2004;43:1178-81. http://dx.doi.org/10.1093/ rheumatology/keh282 · DOI
  11. Bernatsky S, Ramsey-Goldman R, Gordon C, et al. Factors associated with abnormal Pap results in systemic lupus erythematosus. Rheumatology (Oxford) 2004;43:1386-9. http://dx.doi.org/10.1093/ rheumatology/keh331 · DOI
  12. Chopra N, Koren S, Greer WL, et al. Factor V Leiden, prothrombin gene mutation, and thrombosis risk in patients with antiphospholipid antibodies. J Rheumatol 2002;29:1683-8.
  13. Esdaile JM, Abrahamowicz M, Grodzicky T, et al. Traditional Framingham risk factors fail to fully account for accelerated atherosclerosis in systemic lupus erythematosus. Arthritis Rheum 2001;44:2331-7. http://dx.doi. org/10.1002/1529-0131(200110)44:10<2331::AID-ART395≥3.0.CO;2-I 85. Julkunen HA. Oral contraceptives in systemic lupus erythematosus: side-effects and influence on the activity of SLE. Scand J Rheumatol 1991;20:427-33. http://dx.doi.org/10.3109/03009749109096822 · DOI
  14. Jungers P, Dougados M, Pélissier C, et al. Influence of oral contraceptive therapy on the activity of systemic lupus erythematosus. Arthritis Rheum 1982;25:618-23. http://dx.doi.org/10.1002/art.1780250603 · DOI
  15. Manzi S, Meilahn EN, Rairie JE, et al. Age-specific incidence rates of myocardial infarction and angina in women with systemic lupus erythematosus: comparison with the Framingham Study. Am J Epidemiol 1997;145:408-15. http://dx.doi.org/10.1093/oxfordjournals.aje.a009122 · DOI
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Authors
Curtis, K. M., Tepper, N. K., Jatlaoui, T. C., Berry-Bibee, E., Horton, L. G., Zapata, L. B., Simmons, K. B., Pagano, H. P., Jamieson, D. J., & Whiteman, M. K.
Affiliations
  • Centers for Disease Control and Prevention (US)
  • Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
  • University of North Carolina at Chapel Hill (US)
Corresponding author
Curtis, Kathryn M.
ORCID
Venue
MMWR. Recommendations and Reports
Publisher
Centers for Disease Control MMWR Office
Published
2016-07-29
Volume
65
Issue
3
Pages
1-103
ISSN
  • 1057-5987 (ISSN-L)
  • 1545-8601
DOI
10.15585/mmwr.rr6503a1
OpenAlex
W2089971796
Cited by
1,456
References
521
Citations by year
2026: 25 · 2025: 49 · 2024: 120 · 2023: 126 · 2022: 132 · 2021: 143 · 2020: 160 · 2019: 159 · 2018: 131 · 2017: 113 · 2016: 79 · 2015: 61 · 2014: 60 · 2013: 36 · 2012: 33
FWCI
159.33
Type
journal article
Language
en
Open access
Licence
public-domain
Locations
  • MMWR Recommendations and Reports (publishedVersion, public-domain)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Health and Contraception
  • Health Sciences › Health Professions › General Health Professions › Male Reproductive Health Studies
  • Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
Keywords
contraceptive use, medical eligibility criteria, contraceptive choice, family planning, emergency contraception, ulipristal acetate, cystic fibrosis, multiple sclerosis, psychotropic drugs, Hypericum perforatum, postpartum contraception, breastfeeding, dyslipidemia, migraine, superficial venous disease, gestational trophoblastic disease, sexually transmitted infections, HIV, antiretroviral therapy, contraceptive counseling
MeSH terms
Contraindications, Contraception, Contraceptive Agents, Eligibility Determination, Family Planning Services, Female, Health Services Accessibility, Humans, Male, Pregnancy, United States, Practice Guidelines as Topic, Risk Assessment, Pregnancy, Unplanned

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