WHO Medical Eligibility Criteria Wheel for contraceptive use, 2015
Emergency contraceptive pills
| CONDITION | COC | LNG | UPA |
|---|---|---|---|
| Pregnancy | NA | NA | NA |
| Breastfeedinga | 1 | 1 | 2 |
| Post ectopic pregnancy | 1 | 1 | 1 |
| Obesityb (BMI >=30 kg/m2) | 1 | 1 | 1 |
| History of severe cardiovascular disease (ischeamic heart disease, cerebrovascular attack, or other thromoembolic conditions) | 2 | 2 | 2 |
| Migraine | 2 | 2 | 2 |
| Severe liver disease (including jaundice) | 2 | 2 | 2 |
| CYP3A4 inducersC (e.g. rifampicin, phenytoin, phenobarbital, fosphenytoin, nevirapine, oxcarbezipine, primidone, rifabutin, St John's wort/hypericom perforatum) | 1 | 1 | 1 |
| Rape | 1 | 1 | 1 |
- 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 |
|---|---|
| Pregnancy | 4 |
| Rape | |
| a) High risk of STI | 3 |
| b) Low rick of STI | 1 |
| 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
