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

The DOI matches its Crossref record; 535 of the 536 references it cites were found in a registry or an index; none of the 524 sources its claims cite is checked for support yet.

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, Jamieson, Denise J., Whiteman, Maura K.·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.

Overview

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

535 of 536 references verified0 citation errors · 1 not checkable

Statistics

Nothing to recompute.

Verification

Claims the paper makes

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

Show all 197 claims

  • It may state two separate claims as one. 76
  • Probably not a substantial claim. 51
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

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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

Citations

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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.
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Metadata

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
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 › Medicine › Urology › 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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