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WHO Library Cataloguing-in-Publication Data

WHO
WHO medical eligibility criteria wheel for contraceptive use – 2015 update.

1.Contraception - methods. 2.Family Planning Services - methods. 3.Eligibility Determination - standards.
I.World Health Organization.
MEDICAL ELIGIBILITY CRITERIA WHEEL
ISBN 978 92 4 154925 7 (NLM classification: WP 630) FOR CONTRACEPTIVE USE
© World Health Organization 2015

All rights reserved. Publications of the World Health Organization are available on the WHO website (www.who.int) or can be
2015
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The designations employed and the presentation of the material in this publication do not imply the expression of any
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P 3. Combined pills. COC (low dose combined oral contraceptives. Combined contraceptive vaginal ring. 5th edition (2015). POP 6.About this wheel This wheel contains the medical eligibility criteria for starting use of contraceptive methods. Progestogen-only injectables. Copper-bearing intrauterine device. based on Medical Eligibility Criteria for Contraceptive Use. Combined injectable contraceptives. DMPA (IM. CVR 4. Combined contraceptive patch. with ≤ 35 μg ethinyl estradiol) 2. The wheel includes recommendations on initiating use of nine common types of contraceptive methods: 1. Levonorgestrel-releasing intrauterine device. Progestogen-only implants. LNG/ETG (levonorgestrel or etonogestrel) 8. one of WHO’s evidence-based guidelines. Progestogen-only pills.SC)/NET-EN (depot medroxyprogesterone acetate intramuscular or subcutaneous or norethisterone enantate intramuscular) 7. Cu-IUD Antiretroviral Medications and Abbreviations on the MEC Wheel Nucleoside reverse Non-nucleoside reverse transcriptase inhibitors (NRTIs) transcriptase inhibitors (NNRTIs) Protease inhibitors (PIs) ABC Abacavir EFV Efavirenz ATV/r Ritonavir-boosted atazanavir TDF Tenofovir ETR Etravirine LPV/r Ritonavir-boosted lopinavir AZT Zidovudine NVP Nevirapine DRV/r Ritonavir-boosted darunavir 3TC Lamivudine RPV Rilpirivine RTV Ritonavir DDI Didanosine FTC Emtricitabine Integrase Inhibitors D4T Stavudine RAL Raltegravir . CIC 5. LNG-IUD 9. It guides family planning providers in recommending safe and effective contraception methods for women with medical conditions or medically-relevant characteristics.

1 1 1 b) Low risk of STI 1 rifampicin. when the Breastfeeding 1 1 2 time of ovulation can be estimated. carbamazepine. . History of severe 2 2 2 cardiovascular disease The eligibility criteria for general Cu-IUD insertion (ischaemic heart disease. phenytoin. if necessary. there are no safety concerns. NA = not applicable † Emergency contraceptive pills may be less effective among women with BMI ≥ 30 kg/m2 than among women with BMI < 25 kg/m2. However. phenobarbital.Emergency contraceptive pills Copper IUD for Emergency Contraception (Cu-IUD) CONDITION COC LNG UPA This method is highly effective for preventing pregnancy. Obesity (BMI ≥30 kg/m ) † 2 1 1 1 as long as the insertion does not occur more than 5 days after ovulation. also apply for the insertion of Cu-IUDs as emergency cerebrovascular attack. oxcarbazepine. rifabutin. It can be used within 5 days of unprotected intercourse Pregnancy NA NA NA as an emergency contraceptive. fosphenytoin. efavirenz. contraception. UPA = ulipristal acetate. nevirapine. St John’s wort/ hypericum perforatum) Repeated emergency 1 1 1 contraceptive pill use Rape 1 1 1 COC = combined oral contraceptives.g. Despite this. LNG = levonorgestrel. primidone. the Cu-IUD can be Past ectopic pregnancy 1 1 1 inserted beyond 5 days after intercourse. or other thromboembolic CONDITION Cu-IUD conditions) Migraine 2 2 2 Pregnancy 4 Severe liver disease 2 2 2 Rape (including jaundice) a) High risk of STI 3 CYP3A4 inducers (e.

If clinical judgement is limited.How to use this wheel The wheel matches up the contraceptive methods. all the methods are either a category 1 or 2). Only correct and consistent use of condoms. including lactational amenorrhea method. shown on the inner disk. . No restrictions for some conditions: there are many medical conditions when ALL methods can be used (that is. Some of these conditions are listed on the back of the wheel. male or female. all women can safely use emergency contraception. With few exceptions. and categories 3 and 4 both mean the method should not be used. If there is a risk of STI/HIV. please see the full document. The numbers shown in the viewing slot tell you whether the woman who has this known condition or characteristic is able to start use of the contraceptive method: WITH LIMITED CATEGORY WITH CLINICAL JUDGEMENT CLINICAL JUDGEMENT 1 Use method in any circumstance YES (Use the method) 2 Generally use method Use of method not usually recommended unless other more 3 NO appropriate methods are not available or not acceptable (Do not use the method) 4 Method not to be used Categories 1 and 4 are clearly defined recommendations. condom use is recommended. with specific medical conditions or characteristics shown around the outer rim. For categories 2 or 3. categories 1 and 2 both mean the method can be used. for the complete list of recommendations. protect against STI/HIV. greater clinical judgement will be needed and careful follow-up may be required. barrier and behavioral methods of contraception.

A convulsantsT 1 1 1 2/ Z 1 4 1 Certain OPLASIA CANCER CAN AST A 1H 2 4 4 3 anti- W. <4 we s to 4 w NS ING TRA IONS creasedf abortion eks ee <6 w ks to Y In sk o ALL FECT STIs ri Is 1 4D eek s 6 we NU U IN r ST 1 4 D.s with auraS 2M Migraine M.F <6 ek LL EX e th nd O a nitis 4F mo s to nth I 1 PA s S ea a gi RIT ho i va 1 2 2 r yd 1 Y 1 3G Ch onor m AD 1 2 OL la G V 1 3 ESC HI 1 1 3 1 Me o age ars ENT r4 3 1 1 Sta WHO 1 nar 3o t ye <1 S che 1 2 1 8 ge 1 2 VAG ING 1 1 BLE lained 1 1 2 1 Une ther troviral 1 INA 1 ED 1 apy 1 xp 1 4 2E 3 1 1 4A NS L U IBROIDS NE ire 2/3 B 1 1-2 Y Rifabu cin/ Ant 1 1 1 1 AT I O 2 2 2 F 1-2 Y TERIN A 4 1 A 3 1 2 /3 4 2 4 B tin 1 1-2 Y 1 22 i 1 Rifamp MEDIC 3 3A -2 Y A 2 3X 4 E CERVIC 2 1 3 3 . C SEPSIS POSTPART UM A PID ND B REA ED Puerperal <48 hours 4 STF MITT Curre nt 8 hour EED and post.A u H 35 L te/ titis OK I e< 2 S fla 3 a EA M 3 re Q 4 2 Ag 1 2 3 S 3 3 SE L 2 S 2 nt Hi 2 4 re r 1 2M 2M y or st Cu 2 ES Q VE m 24 4 ET g/ OU N B 0k Ac imm 3 >3 BMI 4 ST ute DIA 3/4 4 HR with obilizaio p n lled 0 Y OM Major rolonged contro tely >10 SIT surg r adeq ua >160 / B E factors N disease BO ery o O9 risk 0-9 heart Strok EM 0-159/9 e BOL Multiple 14 Ischaemic ION O ISM RTENS DISEA HYPE CARDIOV SE ASCULAR .V 3U V 2 H 1 4A 1 1 3 2V 1-2 2 AL CERVICAL B 2 1 2 1 M treatment Non.A 2 1 1-2 W 3 3A 1 2/ Z 1 4 2 A 1 3 .S M 2 A 2 2 4S 1 Pre- 2 1 1 2 CHE 1 1 4 1 4 1 1 1 HEADA 1 4 nou 1 1 1 1 Curren 4 3 1 1 1 1 migra R 1 1 1 3 1 E CER 2 1 1 1 2 1 1 t 1 3 1 3 L R 4J 1 3 2 1 2 tum er 2 2 >35 1 2 2 2 Lv 3 i our I 1 M 1 1 LIVE Age L Q 2 2 3/4 K 2 2 2 ING 2M a ep 1 RD 3 c 2 2M 2 1P 2 .

L If established on anticoagulation therapy =2. If ≥15 cigarettes/day H If uterine cavity distorted preventing insertion =4. O If cannot measure blood pressure & no known history of hypertension. DMPA. M If condition developed while on this method. for full names of medications. See jacket P If age <18 yrs & obese DMPA/NET-EN =2. DMPA =1. A If condition develops while using method. COC/P/CVR =4. SC): depot medroxyprogesterone acetate. G If ≥6 wks & not breastfeeding =1. consider primidone or topiramate CIC =2. all women can safely use emergency contraception. ETR. smoking. NET-ET. ATV/r. obesity & known dyslipidaemias. D If <3 wks. I Refers to hepatocellular adenoma (benign) or carcinoma/ S Aura is focal neurological symptoms. including caesarean delivery • Irregular. CIC =2. R If <15 cigarettes/day CIC =2. disease) IUD =3. switching to non-hormonal method. K CIC =3. If no aura & age <35 COC/P/CVR. T Barbituates. C If past pelvic inflammatory disease (PID) all methods =1. including IUDs. If Z If WHO Stage 3 or 4 (severe or advanced HIV clinical complicated or >20 yrs duration. If no aura & age ≥35 COC/P/CVR. diabetes. intramuscular or subcutaneous ETG: etonogestrel LNG: levonorgestrel LNG-IUD: levonorgestrel intrauterine device NET-EN: norethisterone enanthate P: combined contraceptive patch POP: progestogen-only pill . 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. please see the full document. hypertension. NET-EN =3. sickle-cell disease and thalassaemia • Malaria • Mild cirrhosis • Schistosomiasis (bilharzia) • Superficial venous disorders. Either systolic or Y If antiretroviral therapy with EFV. CIC. primidone. carbamazepine. N Risk factors: older age. 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. POP. X CICs =2. 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. LPV/r. B If very high likelihood of exposure to gonorrhoea or chlamydia =3. with other VTE risk factors =3. Q For insulin-dependent & non-insulin-dependent. DRV/r. including cysts • Dysmenorrhoea • Endometriosis • History of gestational diabetes • History of high blood pressure during pregnancy • History of pelvic surgery. diastolic blood pressure may be elevated. not breastfeeding & no other VTE risk factors =3. phenytoin. NVP. “Combined” is a combination of ethinyl estradiol & a progestogen. V If lamotrigine =1. including lactational amenorrhoea method. RTV: COC/P/CVR. W DMPA =1. Implants =2. such as flickering hepatoma (malignant). not breastfeeding & no other VTE risk factors =2. phenytoin. barrier and behavioural methods of contraception. F If 3 to <6 wks. U If barbituates. POP =1. carbamazepine. COC/P/CVR. if carcinoma/hepatoma CIC =3/4. can use all methods. RPV. CIC =3. oxcarbazepine. For all NRTIs. for the complete list of recommendations. CIC: combined injectable contraceptive COC: combined oral contraceptive pill Cu-IUD: copper intrauterine device CVR: combined contraceptive vaginal ring DMPA (IM. can continue using it during treatment. topiramate & lamotrigine. POP =1. J If adenoma CIC =3. lights. oxcarbazepine. CIC =3/4. NET-EN =2. RAL each method =1. E If not breastfeeding =1.

tives Pill. in na l c o n ly pi l jec - mo ogen s DMPA tab or s t c table (IM. If there is a risk of STI/HIV. more appropriate methods are not available or acceptable 2 Generally use the method 4 Method NOT to be used WHO Medical Eligibility Criteria Wheel for contraceptive use. . C e ET rel IUD tog t -EN s VR. pa c e p tch. 2015 These methods do not protect against STI/HIV. male or female. ge ges D Cu-IU r IU D Pro CIC) e or p on p Lev Co 1 Use the method in any 3 Use of the method not usually circumstance recommended unless other. I m Com IUD LNG- P. e inje le h og nly SC ed LNG / (CO o lants ETG )/ bin n- Pr p N C. is recommended. the correct and consistent use of condoms. ra ring ont ls POP .

Switzerland.int/reproductivehealth/en/. and Ms Halley Riley. Dr Mary Lyn Gaffield. This can be accessed at http://www. Dr Tara Jatlaoui.who. This wheel is based upon similar medical eligibility criteria wheels developed independently in Ghana and Jordan. In particular. including guidance on other contraceptive methods. Dr Monica Dragoman. Layout and design: Ms Cath Hamill Ordering copies and further information Detailed information on the medical eligibility criteria. World Health Organization. Dr Kathryn Curtis. 5th edition (2015). and the Johns Hopkins Bloomberg School of Public Health/ Center for Communications Programs for their innovative work. Bulk orders (20 wheels/package) to supply programmes or single orders can be ordered from: WHO Press. we would like to thank the University of Ghana Medical School’s Department of Obstetrics and Gynaecology. appears in the Medical Eligibility Criteria for Contraceptive Use. the Communication Partnership for Family Health in Jordan. email: bookorders@who. in collaboration with Dr Erin Berry-Bibee.Acknowledgements The Medical Eligibility Criteria for Contraceptive Use and this version of the Medical Eligibility Criteria Wheel were developed by the Word Health Organization’s Department of Reproductive Health and Research.int. 1211 Geneva 27. int/bookorders/ .who. Dr Anna Altshuler was responsible for this 2015 edition. Order online: http://apps.