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Appendix A
Summary of Changes to the World Health Organization Medical Eligibility Criteria for Contraceptive Use, 4th Edition, to Create the U.S. Medical Eligibility Criteria for Contraceptive Use, 2010
The classification additions, deletions, and modifications from the World Health Organization (WHO) Medical Eligibility Criteria for Contraceptive Use, 4th Edition, are summarized below (Tables 1--3). For conditions for which classification changed for ≥1 methods or the condition description underwent a major modification, WHO conditions and recommendations appear in curly brackets.
TABLE 1. (Continued) Summary of changes in classifications from WHO Medical Eligibility Criteria for Contraceptive Use, 4th edition*† |
|||||||
---|---|---|---|---|---|---|---|
Condition |
COC/P/R |
POP |
DMPA |
Implants |
LNG-IUD |
Cu-IUD |
Clarification |
i. Higher risk for recurrent DVT/PE (≥1 risk factors) |
2 {1} |
||||||
• Known thrombophilia, including antiphospholipid syndrome |
|||||||
• Active cancer (metastatic, on therapy, or within 6 mos after clinical remission), excluding non-melanoma skin cancer |
|||||||
• History of recurrent DVT/PE |
|||||||
ii. Lower risk for recurrent DVT/PE (no risk factors) |
3§ {4} |
2 {1} |
Women on anticoagulant therapy are at risk for gynecologic complications of therapy such as hemorrhagic ovarian cysts and severe menorrhagia. Hormonal contraceptive methods can be of benefit in preventing or treating these complications. When a contraceptive method is used as a therapy, rather than solely to prevent pregnancy, the risk/benefit ratio may be different and should be considered on a case-by-case basis. {Not included in WHO MEC} |
||||
Valvular heart disease |
|||||||
b. Complicated¶ (pulmonary hypertension, risk for atrial fibrillation, history of subacute bacterial endocarditis) |
1 {2} |
1 {2} |
|||||
Ovarian cancer¶ |
1 {Initiation = 3, Continuation = 2} |
1 {Initiation = 3, Continuation = 2} |
|||||
Uterine fibroids |
2 {1 if no uterine distortion and 4 if uterine distortion is present} |
2 {1 if no uterine distortion and 4 if uterine distortion is present} |
|||||
* For conditions for which classification changed for ≥1 methods or the condition description underwent a major modification, WHO conditions and recommendations appear in curly brackets. † Abbreviations: WHO = World Health Organization; COC = combined oral contraceptive; P = combined hormonal contraceptive patch; R = combined hormonal vaginal ring; POP = progestin-only pill; DMPA = depot medroxyprogesterone acetate; LNG-IUD = levonorgestrel-releasing intrauterine device; Cu-IUD = copper intrauterine device; DVT = deep venous thrombosis; PE = pulmonary embolism; VTE = venous thromboembolism. § Consult the clarification column for this classification. ¶ Condition that exposes a women to increased risk as a result of unintended pregnancy. |
References
- Office on Women's Health, US Department of Health and Human Services. HHS blueprint for action on breastfeeding. Washington, DC: US Department of Health and Human Services, Office on Women's Health; 2000.
- The Criteria Committee of the New York Heart Association. Nomenclature and criteria for diagnosis of diseases of the heart and great vessels. 9th ed. Boston, MA: Little, Brown & Co; 1994.
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