Contraception for Women With Chronic Medical Conditions: Choosing the Right Method

This transcript has been edited for clarity.

Hello. I am Andrew Kaunitz, professor and associate chair in the Department of Obstetrics and Gynecology at the University of Florida College of Medicine in Jacksonville.

Many women of reproductive age have chronic medical conditions, and unplanned pregnancy is associated with increased risks in this population. Accordingly, contraception should be incorporated into the medical care of all women with a new diagnosis or who are currently living with a chronic condition, including those taking teratogenic medications.

The Centers for Disease Control and Prevention's (CDC's) regularly updated Medical Eligibility Criteria for Contraceptive Use designates medical conditions into one of four categories to guide the selection of an appropriate contraceptive method. These categories range from category 1 (medical conditions for which there are no restrictions) to category 4 (a condition for which use of the contraceptive method represents an unacceptable health risk).^[1]

The CDC eligibility criteria are also available on a free, user-friendly app for iOS and Android mobile devices.

The American College of Obstetricians and Gynecologists (ACOG) has recently published a practice bulletin addressing best practices for counseling women with medical conditions regarding contraceptive choices.^[2] These recommendations from ACOG parallel and highlight the CDC guidance. (Full disclosure: Along with Dr Rebecca Allen at the Warren Alpert Medical School of Brown University and Dr Deborah Bartz at Harvard Medical School, I collaborated with ACOG in the preparation of this bulletin.)

Medical conditions addressed by this bulletin include:

• Conditions associated with an elevated risk for venous thromboembolism, including postpartum status and familial thrombophilias;

• Systemic lupus erythematosus;

• Migraine with or without aura;

• Hypertension;

• Diabetes;

• Obesity;

• Depression;

• Family history of breast cancer or known BRCA1 or 2 mutations;

• Personal history of breast cancer;

• Concomitant use of medications including rifampin and liver-enzyme-inducing antiepileptic and antiretroviral medications;

• Older reproductive age, including perimenopausal status; and

• Prior bariatric surgery.

Unintended pregnancies in women with medical conditions are associated with increased maternal and perinatal morbidity as well as mortality. This evidence-based guidance from ACOG will help us in assisting women with medical conditions to make sound choices regarding contraception.

Thank you for the honor of your time. I am Andrew Kaunitz.

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Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.

Cite this: Andrew M. Kaunitz. Contraception for Women With Chronic Medical Conditions: Choosing the Right Method - Medscape - Feb 15, 2019.