CDC's 2024 Contraception Practice Recommendations: The Appendices at a Glance

These appendices accompany CDC's U.S. Selected Practice Recommendations for Contraceptive Use, 2024 (U.S. SPR), and give health care providers quick references for everyday decisions. For complete guidance — including the full condition-by-condition eligibility table — see the full U.S. SPR and the U.S. Medical Eligibility Criteria for Contraceptive Use, 2024 (U.S. MEC).

Appendix A: The four eligibility categories

The U.S. MEC classifies each hormonal method and intrauterine device (IUD) for people with particular conditions or characteristics:

The appendix's summary table applies these categories, condition by condition, to the copper IUD (Cu-IUD), levonorgestrel IUD (LNG-IUD), implant, injectable DMPA (depot medroxyprogesterone acetate), progestin-only pills (POP) and combined hormonal contraceptives (CHC). Consult the U.S. MEC itself for the categories and their clarifications.

Appendix B: When to start each method

Any of these methods can be started at any time if the provider is reasonably certain the patient is not pregnant. Where a start is later in the cycle, back-up means abstaining from sex or using a barrier method such as condoms.

• When a provider is not certain the patient isn't pregnant, the benefits of starting the implant, DMPA, CHC or POP likely exceed any risk; they should be considered at any time, with a follow-up pregnancy test in 2–4 weeks.
• Weight (BMI) does not need to be measured to decide eligibility — every method is U.S. MEC 1 or 2 for people with obesity (BMI of 30 or more) — though a baseline can help in later conversations about weight change.
• STI screening at IUD placement: most patients need no extra screening. A patient with STI risk factors who hasn't been screened for gonorrhea and chlamydia under CDC's STI treatment guidelines may be screened at placement, without delaying it. Patients with current purulent cervicitis, chlamydia or gonorrhea should not have an IUD placed (U.S. MEC 4).

Appendix C: Exams and tests before starting

For healthy patients, each exam or test is classed by how much it matters for safe, effective use of a method:

• Class A — essential and mandatory in all circumstances.
• Class B — contributes substantially, but may be weighed against the benefit of making the method available.
• Class C — does not contribute substantially.

The Class A items are few:

• blood pressure before CHC (a reading taken elsewhere and reported by the patient can be used when a provider can't measure it);
• bimanual examination and cervical inspection before an IUD;
• bimanual examination for diaphragm fitting, and bimanual examination with cervical inspection for cervical cap fitting.

Everything else — clinical breast examination; glucose, lipid, liver enzyme, hemoglobin and thrombophilia tests; Pap tests; HIV screening; and STI screening for non-IUD methods — is Class C for all methods. Condoms, spermicides and vaginal pH modulators need no exam or test. Patients with known medical problems may need more, and preventive screening can be done at the same visit without delaying contraception.

Appendix D: Routine follow-up

No routine follow-up visit is required for healthy users of any of these methods. Patients should know they can contact their provider at any time about side effects or other problems or to switch methods, and IUD, implant and DMPA users should be told when removal or the next injection is due. At other routine visits, providers can:

• ask about satisfaction and concerns with the method;
• check for health changes, including new medications, that would make the method U.S. MEC 3 or 4;
• consider checking for IUD strings (IUD users);
• consider discussing weight changes;
• measure blood pressure (CHC users).

Adolescents and people with certain or multiple medical conditions may benefit from more frequent follow-up.

Appendix E: Bleeding irregularities

Management of bleeding irregularities while using contraception. CDC, MMWR.

If clinically indicated, consider an underlying cause — drug interactions, STIs, pregnancy, thyroid disorders, or new uterine conditions such as polyps or fibroids — and treat it or refer.

Appendix F: IUD users with pelvic inflammatory disease

Managing a copper or levonorgestrel IUD when the user has pelvic inflammatory disease. CDC, MMWR.

CDC's Sexually Transmitted Infections Treatment Guidelines cover the diagnosis and treatment of pelvic inflammatory disease.

Sources

• Centers for Disease Control and Prevention: "Appendices for U.S. Selected Practice Recommendations for Contraceptive Use, 2024," MMWR Recommendations and Reports 73(3), citing Nguyen and others, U.S. Medical Eligibility Criteria for Contraceptive Use, 2024, and the World Health Organization's Selected Practice Recommendations for Contraceptive Use (2004).