COMMENTARY

CDC Contraception Guidelines: The Latest Updates

Katharine Simmons, MD, MPH

Disclosures

June 26, 2017

Editorial Collaboration

Medscape &

As clinicians, we want to provide up-to-date, safe, and evidence-based family planning care. We want to be advocates for our patients and minimize barriers that may prevent them from getting the contraceptive method they want, when they want it. If you need easy-to-access, evidence-based guidance to provide top-quality family planning care, we have tools and guidelines that can help.

Hello. I'm Dr. Katharine Simmons, a guest researcher in the Division of Reproductive Health at the Centers for Disease Control and Prevention (CDC). I am pleased to join you today as part of the CDC Expert Commentary Series on Medscape.

In July 2016, CDC released updates for the US Medical Eligibility Criteria for Contraceptive Use (US MEC)[1] and the US Selected Practice Recommendations for Contraceptive Use (US SPR)[2] to help healthcare providers advise patients about contraceptive choices. I'd like to share how these guidelines can be useful in your clinical practice.

The 2016 US MEC includes recommendations for the safe use of contraceptive methods by women and men who have certain characteristics or medical conditions. Each combination of a medical condition with a contraceptive method is given a numeric recommendation of 1 through 4 indicating whether there is any restriction to its use. There is a summary chart of the 2016 US MEC with a key to numeric recommendations in the lower left corner. As an example, in the diabetes section, women with uncomplicated diabetes have category 1 and 2 recommendations for all contraceptive methods, indicating that all methods are safe (category 1) or that the benefits outweigh the risks (category 2). By contrast, women with complicated diabetes with end-organ disease have category 3 or 4 recommendations for some methods, indicating that risks may outweigh benefits (category 3), or that a method poses an unacceptable health risk (category 4). Each recommendation in the US MEC is based on current available safety evidence.

In addition to hundreds of existing recommendations, the 2016 update includes new recommendations for women with cystic fibrosis or multiple sclerosis, and for women using 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, and women with known dyslipidemias, migraine headaches, superficial venous disease, gestational trophoblastic disease, sexually transmitted diseases (including HIV), or who are using antiretroviral therapy.

Once you have determined that a contraceptive method is safe for your patient, the US SPR assists in addressing common contraceptive management questions. Some examples of recommendations in the US SPR that may be useful to you include guidance for contraceptive initiation and follow-up, how to manage bleeding problems, algorithms to help manage missed contraceptive pills, and guidance for when to consider emergency contraception.

Major updates in 2016 include revised recommendations for starting regular contraception after the use of emergency contraceptive pills and new recommendations for the use of medications to ease insertion of intrauterine devices.

Nearly half of US pregnancies are unintended, and among teens the percentage is even higher—about 75%.[3] The 2016 CDC contraception guidelines provide numerous evidence-based ways to decrease medical barriers to contraception, helping patients plan, prevent, and space pregnancies.

Both sets of guidelines are easy to access online; you can find the links at the end of this transcript. In addition to the complete printed guidelines, our website includes user-friendly charts and algorithms and a smartphone app available for iPhone or Android devices to help you start using the evidence-based recommendations today. You can also find links for other resources to become more familiar with the guidance, including continuing education opportunities.

Please visit our website today and start exploring the US MEC and US SPR.

Web Resources

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