WORLD HEALTH ORGANIZATION MEDICAL ELIGIBILITY FOR INITIATING CONTRACEPTIVE METHODS
These contraceptive methods do not protect against sexually transmitted infections (STIs). Condoms should be used to protect against STIs.
For more information, see: http://www.who.int/reproductive-health/publications/mec/mec.pdf
For more information, see: http://www.who.int/reproductive-health/publications/mec/mec.pdf
| Risk Level | Description |
|---|---|
| 1 | Method can be used without restriction |
| 2 | Advantages generally outweigh theoretical or proven risks |
| 3 | Method not usually recommended unless other, more appropriate methods are not available or not acceptable |
| 4 | Method not to be used |
| Condition | Qualifier for condition | Estrogen/ progestin: pill, patch, ring | Progestin-only: pill | Progestin-only: injection | Progestin-only: implant | Progestin IUD | Copper IUD |
|---|---|---|---|---|---|---|---|
| Anemia | Thalassemia | 1 | 1 | 1 | 1 | 1 | 2 |
| Sickle cell disease | 2 | 1 | 1 | 1 | 1 | 2 | |
| Iron-deficiency anemia | 1 | 1 | 1 | 1 | 1 | 2 | |
| Breast cancer | Family history of cancer | 1 | 1 | 1 | 1 | 1 | 1 |
| Current | 4 | 4 | 4 | 4 | 4 | 1 | |
| In past, no evidence of disease for > 5 years | 3 | 3 | 3 | 3 | 3 | 1 | |
| Breast problems, benign | Undiagnosed mass | 2 | 2 | 2 | 2 | 2 | 1 |
| Benign breast disease | 1 | 1 | 1 | 1 | 1 | 1 | |
| Cervical cancer | Cervical intraepithelial neoplasia | 2 | 1 | 2 | 2 | 2 | 1 |
| Awaiting treatment | 2 | 1 | 2 | 2 | 4 | 4 | |
| Cervical ectropion | 1 | 1 | 1 | 1 | 1 | 1 | |
| Depression | 1 | 1 | 1 | 1 | 1 | 1 | |
| Diabetes mellitus (DM) | History of gestational DM only | 1 | 1 | 1 | 1 | 1 | 1 |
| DM without vascular disease | 2 | 2 | 2 | 2 | 2 | 1 | |
| DM with end-organ damage or > 20 years duration | 3 | 2 | 3 | 2 | 2 | 1 | |
| Drug interactions | Antiretrovirals | 2 | 2 | 2 | 2 | 2 | 2 |
| Certain anticonvulsants | 3 | 3 | 2 | 3 | 1 | 1 | |
| Griseofulvin | 2 | 2 | 1 | 2 | 1 | 1 | |
| Rifampin | 3 | 3 | 2 | 3 | 1 | 1 | |
| ALL OTHER ANTIBIOTICS | 1 | 1 | 1 | 1 | 1 | 1 | |
| Endometrial cancer | 1 | 1 | 1 | 1 | 4 | 4 | |
| Endometriosis | 1 | 1 | 1 | 1 | 1 | 2 | |
| Gallbladder disease | Asymptomatic gallstones | 2 | 2 | 2 | 2 | 2 | 1 |
| Symptomatic gallstones, without cholecystectomy | 3 | 2 | 2 | 2 | 2 | 1 | |
| Gallstones treated with cholecystectomy | 2 | 2 | 2 | 2 | 2 | 1 | |
| Pregnancy-related cholestasis in past | 2 | 1 | 1 | 1 | 1 | 1 | |
| Hormone-related cholestasis in past | 3 | 2 | 2 | 2 | 2 | 1 | |
| Headaches | Non-migranous | 1 | 1 | 1 | 1 | 1 | 1 |
| Headaches: migraines | Without aura, age < 35 | 2 | 1 | 2 | 2 | 2 | 1 |
| Without aura, age > 35 | 3 | 1 | 2 | 2 | 2 | 1 | |
| With aura, any age | 4 | 2 | 2 | 2 | 2 | 1 | |
| HIV infection | High risk | 1 | 1 | 1 | 1 | 2 | 2 |
| HIV infected | 1 | 1 | 1 | 1 | 2 | 2 | |
| AIDS (without drug interactions) | 1 | 1 | 1 | 1 | 3 | 3 | |
| Hypertension | During prior pregnancy only – now resolved | 2 | 1 | 1 | 1 | 1 | 1 |
| Well controlled | 3 | 1 | 2 | 1 | 1 | 1 | |
| Systolic 140-159 or diastolic 90-99 | 3 | 1 | 2 | 1 | 1 | 1 | |
| Systolic > 160 or diastolic > 100 | 4 | 2 | 3 | 2 | 2 | 1 | |
| With vascular disease | 4 | 2 | 3 | 2 | 2 | 1 | |
| Ischemic heart disease | Past or current | 4 | 2 | 3 | 2 | 2 | 1 |
| Liver Disease | Cirrhosis-mil | 3 | 2 | 2 | 2 | 2 | 1 |
| Cirrhosis-severe | 4 | 3 | 3 | 3 | 3 | 1 | |
| Tumors-benign | 4 | 3 | 3 | 3 | 3 | 1 | |
| Tumors-malignant | 4 | 3 | 3 | 3 | 3 | 1 | |
| Viral hepatitis-carrier | 1 | 1 | 1 | 1 | 1 | 1 | |
| Viral hepatitis-active | 4 | 3 | 3 | 3 | 3 | 1 | |
| Obesity | BMI > 30 kg/meter squared | 2 | 1 | 1 | 1 | 1 | 1 |
| Ovarian cancer | 1 | 1 | 1 | 1 | 3 | 3 | |
| Ovarian cysts | & benign tumors | 1 | 1 | 1 | 1 | 1 | 1 |
| Pelvic inflammatory disease | Past, with subsequent pregnancy | 1 | 1 | 1 | 1 | 1 | 1 |
| Past, without subsequent pregnancy | 1 | 1 | 1 | 1 | 2 | 2 | |
| Current | 1 | 1 | 1 | 1 | 4 | 4 | |
| Postpartum, not breastfeeding | < 48 hours | 3 | 1 | 1 | 1 | 3 | 2 |
| 2-21 days | 3 | 1 | 1 | 1 | 3 | 3 | |
| 3-4 weeks | 1 | 1 | 1 | 1 | 3 | 3 | |
| > 4 weeks | 1 | 1 | 1 | 1 | 1 | 1 | |
| Postpartum & breastfeeding | < 6 weeks postpartum | 4 | 3 | 3 | 3 | Same as postpartum, not breastfeeding | |
| 6 weeks – 6 months postpartum | 3 | 1 | 1 | 1 | 1 | 1 | |
| > 6 months postpartum | 2 | 1 | 1 | 1 | 1 | 1 | |
| Post-abortion | First trimester | 1 | 1 | 1 | 1 | 1 | 1 |
| Second trimester | 1 | 1 | 1 | 1 | 2 | 2 | |
| Immediately after septic abortion | 1 | 1 | 1 | 1 | 4 | 4 | |
| Sexually Transmitted Infections | Vaginitis | 1 | 1 | 1 | 1 | 2 | 2 |
| High risk | 1 | 1 | 1 | 1 | 3 | 3 | |
| Current GC/Chlamydia/Purulent cervicitis | 1 | 1 | 1 | 1 | 4 | 4 | |
| Smoking | Age < 35 | 2 | 1 | 1 | 1 | 1 | 1 |
| Age > 35, < 15 cigarettes/day | 3 | 1 | 1 | 1 | 1 | 1 | |
| Age > 35, > 15 cigarettes/day | 4 | 1 | 1 | 1 | 1 | 1 | |
| Seizure disorder | Without drug interactions | 1 | 1 | 1 | 1 | 1 | 1 |
| Stroke | 4 | 2 | 3 | 2 | 2 | 1 | |
| Surgery | Minor, without prolonged immobilization | 1 | 1 | 1 | 1 | 1 | 1 |
| Major, without prolonged immobilization | 2 | 1 | 1 | 1 | 1 | 1 | |
| Major, with prolonged immobilization | 4 | 2 | 2 | 2 | 2 | 1 | |
| Thyroid disorders | Simple goiter, hyperthyroidism, hypothyroidism | 1 | 1 | 1 | 1 | 1 | 1 |
| Uterine fibroids | Without distortion of uterine cavity | 1 | 1 | 1 | 1 | 1 | 1 |
| With distortion of uterine cavity | 1 | 1 | 1 | 1 | 4 | 4 | |
| Valvular heart disease | Uncomplicated | 2 | 1 | 1 | 1 | 1 | 1 |
| Complicated | 4 | 1 | 1 | 1 | 2 | 2 | |
| Varicose veins | 1 | 1 | 1 | 1 | 1 | 1 | |
| Venous thrombosis | Family history (1st-degree relatives) | 2 | 1 | 1 | 1 | 1 | 1 |
| Superficial thrombophlebitis | 2 | 1 | 1 | 1 | 1 | 1 | |
| Past DVT | 4 | 2 | 2 | 2 | 2 | 1 | |
| Current DVT | 4 | 3 | 3 | 3 | 3 | 1 | |