World Health Organization
Human Reproduction Programme

WHO Medical Eligibility Criteria Wheel for contraceptive use, 2015

EC
Emergency contraceptive pills
CONDITION COC LNG UPA
PregnancyNANANA
Breastfeedinga112
Post ectopic pregnancy111
Obesityb (BMI >=30 kg/m2)111
History of severe cardiovascular disease (ischeamic heart disease, cerebrovascular attack, or other thromoembolic conditions)222
Migraine222
Severe liver disease (including jaundice)222
CYP3A4 inducersC (e.g. rifampicin, phenytoin, phenobarbital, fosphenytoin, nevirapine, oxcarbezipine, primidone, rifabutin, St John's wort/hypericom perforatum)111
Rape111
  • a - Breastfeeding is not recommended for one week after taking UPA since it is excreted in breast milk. Breast milk should be expressed and discarded during that time
  • b - ECPs may be less effective among women with BMI ≥ 30 kg/m2 than among women with BMI < 25 kg/m2. Despite this, there are no safety concerns.
  • c - Strong CYP3A4 inducers may reduce the effectiveness of emergency contraceptive pills.
  • d - Repeated ECP use is an indication that the woman requires further counselling on other contraceptive options. Frequently repeated ECP use may be harmful for women with conditions classified as 2, 3 or 4 for contraceptives containing hormones.
Copper IUD for Emergency Contraception

This method is highly effective for preventing pregnancy. It can be used within 5 days of unprotected intercourse as an emergency contraceptive. However, when the time of ovulation can be estimated, the Cu-IUD can be inserted beyond 5 days after intercourse, if necessary, as long as the insertion does not occur more than 5 days after ovulation.

The eligibility criteria for general Cu-IUD insertion also apply for the insertion of Cu-IUDs as emergency contraception.

CONDITION Cu-IUD
Pregnancy4
Rape
a) High risk of STI3
b) Low rick of STI1
A If condition develops while using method, can continue using it during treatment.
B If very high likelihood of exposure to gonorrhoea or chlamydia=3.
C If past pelvic inflammatory disease (PID) all methods=1, including IUDs.
D If <3 wks, not breastfeeding & no other VTE risk factors=3.
E If not breastfeeding=1.
F If 3 to <6 wks, not breastfeeding & no other VTE risk factors=2, with other VTE risk factors=3.
G If ≥6 wks & not breastfeeding=1.
H If uterine cavity distorted preventing insertion=4.
I Refers to hepatocellular adenoma (benign) or carcinoma/hepatoma (malignant).
J If adenoma CIC=3, if carcinoma/hepatoma CIC=3/4.
K CIC=3.
L If established on anticoagulation therapy=2.
M If condition developed while on this method, consider switching to non-hormonal method.
N Risk factors: older age, smoking, diabetes, hypertension, obesity & known dyslipidaemias.
O If cannot measure blood pressure & no known history of hypertension, can use all methods. Either systolic or diastolic blood pressure may be elevated.
P If age <18 yrs & obese DMPA/NET-EN=2.
Q For insulin-dependent & non-insulin-dependent. If complicated or >20 yrs duration, COC/P/CVR, CIC=3/4; DMPA, NET-EN=3.
R If <15 cigarettes/day CIC=2. If ≥15 cigarettes/day COC/P/CVR=4.
S Aura is focal neurological symptoms, such as flickering lights. If no aura & age <35 COC/P/CVR, CIC=2, POP=1. If no aura & age ≥35 COC/P/CVR, CIC=3, POP=1.
T Barbituates, carbamazepine, oxcarbazepine, phenytoin, primidone, topiramate & lamotrigine.
U If barbituates, carbamazepine, oxcarbazepine, phenytoin, primidone or topiramate CIC=2.
V If lamotrigine=1.
W DMPA=1
NET-EN=2.
X CICs=2.
Y If antiretroviral therapy with EFV, NVP, ATV/r, LPV/r, DRV/r, RTV: COC/P/CVR, CIC, POP, NET-ET, Implants=2; DMPA=1. For all NRTIs, ETR, RPV, RAL each method=1. See jacket for full names of medications.
Z If WHO Stage 3 or 4 (severe or advanced HIV clinical disease) IUD=3.

Conditions that are category 1 and 2 for all methods (method can be used)

Reproductive Conditions: Benign breast disease or undiagnosed mass • Benign ovarian tumours, including cysts • Dysmenorrhoea • Endometriosis • History of gestational diabetes • History of high blood pressure during pregnancy • History of pelvic surgery, including caesarean delivery • Irregular, heavy or prolonged menstrual bleeding (explained) • Past ectopic pregnancy • Past pelvic inflammatory disease • Post-abortion (no sepsis) • Postpartum ≥ 6 months

Medical Conditions: Depression • Epilepsy • HIV asymptomatic or mild clinical disease (WHO Stage 1 or 2) • Iron-deficiency anaemia, sickle-cell disease and thalassaemia • Malaria • Mild cirrhosis • Schistosomiasis (bilharzia) • Superficial venous disorders, including varicose veins • Thyroid disorders • Tuberculosis (non-pelvic) • Uncomplicated valvular heart disease • Viral hepatitis (carrier or chronic)

Other: Adolescents • Breast cancer family history • Venous thromboembolism (VTE) family history • High risk for HIV • Surgery without prolonged immobilization • Taking antibiotics (excluding rifampicin/rifabutin)

With few exceptions, all women can safely use emergency contraception, barrier and behavioural methods of contraception, including lactational amenorrhoea method; for the complete list of recommendations, please see the full document.

“Combined” is a combination of ethinyl estradiol & a progestogen.

CIC: combined injectable contraceptive COC: combined oral contraceptive pill Cu-IUD: copper intrauterine device CVR: combined contraceptive vaginal ring DMPA (IM, SC): depot medroxyprogesterone acetate, intramuscular or subcutaneous ETG: etonogestrel LNG: levonorgestrel LNG-IUD: levonorgestrel intrauterine device NET-EN: norethisterone enanthate P: combined contraceptive patch POP: progestogen-only pill

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