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The U.S. Medical Eligibility Criteria for Contraceptive Use (U.S. MEC) is CDC's guidance for health care providers on which contraceptive methods are safe for women and men with particular characteristics or medical conditions. This page covers the 2016 edition, which updated the first U.S. MEC of 2010. CDC has since published a newer update.
Why it exists
About 45% of U.S. pregnancies are unintended, bringing higher risks for mothers and babies and higher health care costs. People have more safe, effective options than ever — including long-acting reversible contraception (LARC): intrauterine devices (IUDs) and implants. The guidance aims to remove unnecessary medical barriers to contraception, so fewer pregnancies are unintended.
The 2010 U.S. MEC was adapted from the World Health Organization's global guidance. Its companion, the U.S. Selected Practice Recommendations (U.S. SPR), covers how to use a method safely and effectively once it's judged medically appropriate. The recommendations are clinical guidance, not a substitute for individual medical advice: providers should always weigh each person's own circumstances.
The four categories
Each pairing of a method and a condition gets a category:
| Category | Meaning | In practice |
|---|---|---|
| 1 | no restriction on use | use the method |
| 2 | advantages generally outweigh the theoretical or proven risks | generally usable; careful follow-up may be needed |
| 3 | theoretical or proven risks usually outweigh the advantages | usually not recommended unless other suitable methods aren't available or acceptable; needs careful clinical judgment and follow-up |
| 4 | an unacceptable health risk | don't use |
Example — combined oral contraceptives (COCs) and smoking:
| Woman | Category |
|---|---|
| smoker under 35 | 2 |
| 35 or older, fewer than 15 cigarettes a day | 3 |
| 35 or older, 15 or more a day | 4 — mainly because of the risk of heart attack and stroke |
Categories can differ for starting a method and continuing it — which matters when a condition develops or worsens during use. The guidance rates methods used for contraception, not for treating a medical condition.
Methods covered
- Intrauterine: copper IUD and levonorgestrel IUDs
- Progestin-only: etonogestrel implants, depot medroxyprogesterone acetate injections, progestin-only pills
- Combined hormonal: low-dose COCs (35 μg ethinyl estradiol or less), the patch and the vaginal ring
- Barrier: male and female condoms, spermicides, diaphragm with spermicide, cervical cap
- Fertility awareness–based methods, the lactational amenorrhea method and withdrawal
- Female and male sterilization
- Emergency contraception: the copper IUD and emergency contraceptive pills
What changed in 2016
| New conditions | cystic fibrosis, multiple sclerosis, certain psychotropic drugs, St. John's wort |
| Emergency contraception | revised, adding ulipristal acetate |
| Revised | postpartum and breastfeeding women; dyslipidemias; migraine; superficial venous disease; gestational trophoblastic disease; STDs; HIV; antiretroviral therapy |
CDC tracked new research through the WHO/CDC continuous identification of research evidence (CIRE) system, with weekly PubMed searches. It met with 11 family planning experts in Atlanta in August 2014 to scope the update, commissioned systematic reviews, and held a 44-person expert meeting in August 2015. CDC then set the recommendations itself, and three outside reviewers checked them for accuracy, feasibility and clarity.
Choosing a method
Category 1 means a method is safe for someone — not necessarily their best choice. Effectiveness, availability (including cost and access) and acceptability matter too, and voluntary, informed choice is essential.
- Effectiveness depends on the method and on using it consistently and correctly. IUDs and implants are highly effective because they don't rely on the user's routine, and they suit most women, including adolescents and women who haven't given birth.
- Hormonal methods and IUDs don't protect against STDs or HIV. Consistent, correct use of male latex condoms lowers the risk of HIV, chlamydia, gonorrhea and trichomoniasis; female condoms may help too. Everyone should be counseled about condoms and STD risk, whatever their method. See CDC's STD treatment guidelines.
When pregnancy itself is risky
For women whose health would make pregnancy dangerous — or who take drugs that can harm a pregnancy — long-acting, highly effective methods may be the best choice. Barrier and behavior-based methods alone may not be, because they fail more often with typical use. Conditions that raise the risk of pregnancy include:
| Cancers | breast; endometrial or ovarian; hepatocellular adenoma and malignant liver tumors |
| Heart and blood vessels | complicated valvular heart disease; ischemic heart disease; peripartum cardiomyopathy; stroke; hypertension (systolic 160 mm Hg or more, or diastolic 100 or more); thrombogenic mutations |
| Chronic disease | cystic fibrosis; epilepsy; sickle cell disease; systemic lupus erythematosus; severe (decompensated) cirrhosis |
| Diabetes | insulin-dependent; with nephropathy, retinopathy, neuropathy or other vascular disease; or of more than 20 years' duration |
| Infection | HIV in someone not clinically well or not on antiretroviral therapy; tuberculosis; schistosomiasis with liver fibrosis |
| Recent procedures | bariatric surgery or solid organ transplant within the past 2 years |
| Pregnancy-related | gestational trophoblastic disease |
Keeping it current
The U.S. MEC generally follows WHO's updates, usually every 5 years or sooner, with CDC reviewing each for U.S. use and checking evidence on conditions WHO doesn't cover; CDC also fully reviews the U.S. MEC every 5 years.
Sources
Based on Kathryn M. Curtis, Naomi K. Tepper, Tara C. Jatlaoui and colleagues, "U.S. Medical Eligibility Criteria for Contraceptive Use, 2016," MMWR Recommendations and Reports, volume 65, Centers for Disease Control and Prevention, which builds on the World Health Organization's Medical Eligibility Criteria for Contraceptive Use, 5th edition; a work of the United States government in the public domain.
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