Skip to main content

Advertisement

Log in

Putting risk into perspective: The US medical eligibility criteria for contraceptive use

  • Published:
Reviews in Endocrine and Metabolic Disorders Aims and scope Submit manuscript

Abstract

Unintended pregnancy remains a considerable problem in the United States, with health risks for both mother and infant. These risks may be increased among women with medical conditions, for whom pregnancy can lead to severe adverse outcomes. Highly effective and safe contraceptive methods are available to prevent unintended pregnancy. However, women with medical conditions and their providers also may be concerned about potential risks associated with contraceptive method use. Evidence-based guidance documents can be helpful tools for clinicians to efficiently use evidence and put risks into perspective. The US Medical Eligibility Criteria for Contraceptive Use, 2010, provides evidence-based recommendations for the safety of contraceptive use among women with medical conditions and other characteristics. While some contraceptive methods pose risks for some women, these must be considered in context and weighed against such considerations as the absolute risk of adverse events and the risks associated with pregnancy. Most women, even women with medical conditions, can safely use highly effective methods of contraception and promoting their use will further efforts to reduce unintended pregnancy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. Finer LB, Henshaw SK. Disparities in rates of unintended pregnancy in the United States, 1994 and 2001. Perspect Sex Reprod Health. 2006;38:90–6.

    Article  PubMed  Google Scholar 

  2. Kost K, Landry DJ, Darroch JE. Predicting maternal behaviors during pregnancy: does intention status matter? Fam Plann Perspect. 1998;30:79–88.

    Article  PubMed  CAS  Google Scholar 

  3. Gipson JD, Koenig MA, Hindin MJ. The effects of unintended pregnancy on infant, child, and parental health: a review of the literature. Stud Fam Plann. 2008;39:18–38.

    Article  PubMed  Google Scholar 

  4. Blumenthal PD, Edelman A. Hormonal contraception. Obstet Gynecol. 2008;112:670–84.

    Article  PubMed  Google Scholar 

  5. Madden T, Allsworth JE, Hladky KJ, Secura GM, Peipert JF. Intrauterine contraception in Saint Louis: a survey of obstetrician and gynecologists’ knowledge and attitudes. Contraception. 2010;81:112–6.

    Article  PubMed  Google Scholar 

  6. Kaye K, Suellentrop K, Sloup C. The fog zone: how misperceptions, magical thinking, and ambivalence put young adults at risk for unplanned pregnancy. Washington, DC: The National Campaign to Prevent Teen and Unplanned Pregnancy; 2009.

    Google Scholar 

  7. Steiner MJ, Trussell J, Mehta N, Condon S, Subramaniam S, Bourne D. Communicating contraceptive effectiveness: a randomized controlled trial to inform a World Health Organization family planning handbook. Am J Obstet Gynecol. 2006;195:85–91.

    Article  PubMed  Google Scholar 

  8. Centers for Disease Control and Prevention. US medical eligibility criteria for contraceptive use, 2010. MMWR. 2010;59:1–85.

    Google Scholar 

  9. Woolf SH, Grol R, Hutchinson A, Eccles M, Grimshaw J. Clinical guidelines: potential benefits, limitations, and harms of clinical guidelines. BMJ. 1999;318:527–30.

    PubMed  CAS  Google Scholar 

  10. Shaneyfelt TM, Centor RM. Reassessment of clinical practice guidelines: go gently into that good night. JAMA. 2009;301:868–9.

    Article  PubMed  CAS  Google Scholar 

  11. Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS. Evidence based medicine: what it is and what it isn’t. BMJ. 1996;312:71–2.

    PubMed  CAS  Google Scholar 

  12. Sawaya GF, Guirguis-Blake J, LeFevre M, Harris R, Petitti D. Update on the methods of the U.S. Preventive Services Task Force: estimating certainty and magnitude of net benefit. Ann Intern Med. 2007;147:871–5.

    PubMed  Google Scholar 

  13. Shelton JD, Angle MA, Jacobstein RA. Medical barriers to access to family planning. Lancet. 1992;340:1334–5.

    Article  PubMed  CAS  Google Scholar 

  14. World Health Organization. Medical eligibility criteria for contraceptive use. 4th ed. Geneva: World Health Organization; 2010.

    Google Scholar 

  15. Curtis KM, Jamieson DJ, Peterson HB, Marchbanks PA. Adaptation of the World Health Organization’s medical eligibility criteria for contraceptive use for use in the United States. Contraception. 2010;82:3–9.

    Article  PubMed  Google Scholar 

  16. Folger SG, Curtis KM, Tepper NK, Gaffield ME, Marchbanks PA. Guidance on medical eligibility criteria for contraceptive use: identification of research gaps. Contraception. 2010;82:113–8.

    Article  PubMed  Google Scholar 

  17. Gillum LA, Mamidipudi SK, Johnston SC. Ischemic stroke risk with oral contraceptives: a meta-analysis. JAMA. 2000;284:72–78.

    Article  PubMed  CAS  Google Scholar 

  18. Grimes DA, Schulz KF. Surrogate end points in clinical research: hazardous to your health. Obstet Gynecol. 2005;105:1114–8.

    Article  PubMed  Google Scholar 

  19. Curtis KM, Martins SL. Progestogen-only contraception and bone mineral density: a systematic review. Contraception. 2006;73:470–87.

    Article  PubMed  CAS  Google Scholar 

  20. Kaunitz AM, Arias R, McClung M. Bone density recovery after depot medroxyprogesterone acetate injectable contraception use. Contraception. 2008;77:67–76.

    Article  PubMed  CAS  Google Scholar 

  21. Vandenbroucke JP, Rosing J, Bloemenkamp KW, Middledorp S, Helmerhorst FM, Bouma B, et al. Oral contraceptives and the risk of venous thrombosis. N Engl J Med. 2001;344:1527–35.

    Article  PubMed  CAS  Google Scholar 

  22. Heit JA, Kobbervig CE, James AH, Petterson TM, Bailey KR, Melton III LJ. Trends in the incidence of venous thromboembolism during pregnancy or postpartum: a 30-year population-based study. Ann Intern Med. 2005;143:697–706.

    PubMed  Google Scholar 

  23. Flegal KM, Carroll MD, Ogden CL, Curtin LR. Prevalence and trends in obesity among US adults, 1999–2008. JAMA. 2010;303:235–41.

    Article  PubMed  CAS  Google Scholar 

  24. Tsoi E, Shaikh H, Robinson S, Teoh TG. Obesity in pregnancy: a major healthcare issue. Postgrad Med J. 2010;86:617–23.

    Article  PubMed  Google Scholar 

  25. Lopez LM, Grimes DA, Chen-Mok M, Westhoff C, Edelman A, Helmerhorst FM. Hormonal contraceptives for contraception in overweight or obese women. Cochrane Database Syst Rev 2010;CD008452.

  26. Trussell J, Schwarz EB, Guthrie K. Obesity and oral contraceptive pill failure. Contraception. 2009;79:334–8.

    Article  PubMed  Google Scholar 

  27. Trussell J, Guthrie KA, Schwarz EB. Much ado about little: obesity, combined hormonal contraceptive use and venous thrombosis. Contraception. 2008;77:143–6.

    Article  PubMed  CAS  Google Scholar 

  28. Herrinton LJ, Liu L, Lewis JD, Griffin PM, Allison J. Incidence and prevalence of inflammatory bowel disease in a Northern California managed care organization, 1996–2002. Am J Gastroenterol. 2008;103:1998–2006.

    Article  PubMed  Google Scholar 

  29. Alstead EM. Inflammatory bowel disease in pregnancy. Postgrad Med J. 2002;78:23–6.

    Article  PubMed  CAS  Google Scholar 

  30. Cornish J, Tan E, Teare J, et al. A meta-analysis on the influence of inflammatory bowel disease on pregnancy. Gut. 2007;56:830–7.

    Article  PubMed  CAS  Google Scholar 

  31. Faculty of Family Planning and Reproductive Health Care Clinical Effectriveness Unit. Contraceptive choices for women with inflammatory bowel disease. J Fam Plann Reprod Health Care. 2003;29:127–35.

    Article  Google Scholar 

  32. Zapata LB, Paulen ME, Cansino C, Marchbanks PA, Curtis KM. Contraceptive use among women with inflammatory bowel disease: A systematic review. Contraception. 2010;82:72–85.

    Article  PubMed  Google Scholar 

  33. Heinemann LA, Dinger JC. Range of published estimates of venous thromboembolism incidence in young women. Contraception. 2007;75:328–36.

    Article  PubMed  Google Scholar 

  34. Centers for Disease Control and Prevention. National diabetes fact sheet: general information and national estimates on diabetes in the United States, 2007. http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2007.pdf 2008 [cited 2011 Jan 5].

  35. Fox CS, Pencina MJ, Meigs JB, Vasan RS, Levitzky YS, D’Agostino Sr RB. Trends in the incidence of type 2 diabetes mellitus from the 1970s to the 1990s: the Framingham Heart Study. Circulation. 2006;113:2914–8.

    Article  PubMed  Google Scholar 

  36. Hawthorne G. Maternal complications in diabetic pregnancy. Best Pract Res Clin Obstet Gynaecol 2010.

  37. Skouby SO. Hormonal contraception in obesity, the metabolic syndrome, and diabetes. Ann NY Acad Sci. 2010;1205:240–4.

    Article  PubMed  Google Scholar 

  38. Kitzmiller JL, Wallerstein R, Correa A, Kwan S. Preconception care for women with diabetes and prevention of major congenital malformations. Birth Defects Res A Clin Mol Teratol. 2010;88:791–803.

    Article  PubMed  CAS  Google Scholar 

  39. Kjos SL. Contraception in diabetic women. Obstet Gynecol Clin North Am. 1996;23:243–58.

    Article  PubMed  CAS  Google Scholar 

  40. Grigoryan OR, Grodnitskaya EE, Andreeva EN, Shestakova MV, Melnichenko GA, Dedov II. Contraception in perimenopausal women with diabetes mellitus. Gynecol Endocrinol. 2006;22:198–206.

    Article  PubMed  CAS  Google Scholar 

  41. Diab KM, Zaki MM. Contraception in diabetic women: comparative metabolic study of Norplant, depot medroxyprogesterone acetate, low dose oral contraceptive pill and CuT380A. J Obstet Gynaecol Res. 2000;26:17–26.

    Article  PubMed  CAS  Google Scholar 

  42. Margolis KL, Adami HO, Luo J, Ye W, Weiderpass E. A prospective study of oral contraceptive use and risk of myocardial infarction among Swedish women. Fertil Steril. 2007;88:310–6.

    Article  PubMed  Google Scholar 

  43. Klein BE, Moss SE, Klein R. Oral contraceptives in women with diabetes. Diabetes Care. 1990;13:895–8.

    Article  PubMed  CAS  Google Scholar 

  44. Garg SK, Chase HP, Marshall G, Hoops SL, Holmes DL, Jackson WE. Oral contraceptives and renal and retinal complications in young women with insulin-dependent diabetes mellitus. JAMA. 1994;271:1099–102.

    Article  PubMed  CAS  Google Scholar 

  45. Trussell J. Contraceptive failure in the United States. Contraception. 2004;70:89–96.

    Article  PubMed  Google Scholar 

  46. Mosher WD, Jones J. Use of contraception in the United States: 1982–2008. Vital Health Stat. 2010;23:1–44.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Kathryn M. Curtis.

Additional information

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Curtis, K.M., Tepper, N.K. & Marchbanks, P.A. Putting risk into perspective: The US medical eligibility criteria for contraceptive use. Rev Endocr Metab Disord 12, 119–125 (2011). https://doi.org/10.1007/s11154-011-9177-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11154-011-9177-1

Keywords

Navigation