There is no medical reason to deny sterilization to a person with this condition.
C = caution
The procedure is normally conducted in a routine setting, but with extra preparation and precautions.
D = delay
The procedure is delayed until the condition is evaluated and/or corrected. Alternative temporary methods of contraception should be provided.
S = special
The procedure should be undertaken in a setting with an experienced surgeon and staff, equipment needed to provide general anaesthesia, and other back-up medical support. For these conditions, the capacity to decide on the most appropriate procedure and anaesthesia regimen is also needed. Alternative temporary methods of contraception should be provided if referral is required or there is otherwise any delay.
No breastfeeding status was selected using the "Women’s characteristics" filters.
Breastfeeding
Category
Clarifications/Special considerations
a) < 6 weeks postpartum
3
Clarification: There is theoretical concern about the potential exposure of the neonate to DMPA/NET-EN during the first 6 weeks postpartum.
In many settings, however, pregnancy-related morbidity and mortality risks are high, and access to services is limited. In such settings, DMPA/NET-EN may be among the few methods widely available and accessible to breastfeeding women immediately postpartum.
b) ≥ 6 weeks to < 6 months postpartum (primarily breastfeeding)
1
c) ≥ 6 months postpartum
1
Non-breastfeeding
Category
Clarifications/Special considerations
a) < 21 days
1
b) ≥ 21 days
1
Medical Condition:
No medical conditions were selected using the "Women’s characteristics" filters.
Cardiovascular disease
Category
Clarifications/Special considerations
Current and history of ischaemic heart disease
3
Stroke
3
Diabetes
Category
Clarifications/Special considerations
a) History of gestational disease
1
b) Non-vascular disease
i) non-insulin dependent
2
ii) insulin dependent
2
c) Nephropathy / retinopathy / neuropathy
3
d) Other vascular disease or diabetes of > 20 years’ duration
3
Headaches
Category
Clarifications/Special considerations
I
C
a) Non-migrainous (mild or severe)
1
1
Clarification: Classification depends on accurate diagnosis of those severe headaches that are migrainous and those that are not. Read More
b) Migraine
i) without aura
age < 35 years
2
2
age > 35 years
2
2
ii) with aura, at any age
2
3
Headaches / Migraine
Clarification: Classification depends on accurate diagnosis of those severe headaches that are migrainous and those that are not. Any new headaches or marked changes in headaches should be evaluated. Classification is for women without any other risk factors for stroke. Risk of stroke increases with age, hypertension and smoking.
HIV WHO Stage 3 or 4
Category
Clarifications/Special considerations
Severe or advanced HIV clinical disease (WHO stage 3 or 4)
1
Clarification: Because there may be drug interactions between hormonal contraceptives and ARV therapy, refer to Drug Interactions. Read More
HIV WHO Stage 3 or 4
Clarification: Because there may be drug interactions between hormonal contraceptives and ARV therapy, refer to Drug Interactions.
Available studies on the association between progestogen-only injectable contraception and HIV acquisition have important methodological limitations hindering their interpretation. Some studies suggest that women using progestogen-only injectable contraception may be at increased risk of HIV acquisition; other studies have not found this association. The public health impact of any such association would depend upon the local context, including rates of injectable contraceptive use, maternal mortality, and HIV prevalence. This must be considered when adapting guidelines to local contexts. WHO expert groups continue to actively monitor any emerging evidence. At the meeting in 2014, as at the 2012 technical consultation, it was agreed that the epidemiological data did not warrant a change to the MEC. Given the importance of this issue, women at high risk of HIV infection should be informed that progestogen-only injectables may or may not increase their risk of HIV acquisition. Women and couples at high risk of HIV acquisition considering progestogen-only injectables should also be informed about and have access to HIV preventive measures, including male and female condoms.
Hypertension
Category
Clarifications/Special considerations
a) History of hypertension, where blood pressure CANNOT be evaluated (including hypertension in pregnancy)
2
Clarification: It is desirable to have blood pressure measurements taken before initiation of POC, use. Read More
b) Adequately controlled hypertension, where blood pressure CAN be evaluated
2
c) Elevated blood pressure levels (properly taken measurements)
i) systolic 140-159 or diastolic 90-99 mm Hg
2
ii) systolic ≥ 160 or diastolic ≥ 100 mm Hg
3
d) Vascular disease
Hypertension
Clarification: It is desirable to have blood pressure measurements taken before initiation of POC
use. However, in some settings blood pressure measurements are unavailable. In many of these settings, pregnancy-related morbidity and mortality risks are high, and POCs are among the few types of methods widely available. In such settings, women should not be denied the use of POCs simply because their blood pressure cannot be measured.
Clarification: Women adequately treated for hypertension are at reduced risk of acute myocardial infarction (MI) and stroke as compared with untreated women. Although there are no data, POC users with adequately controlled and monitored hypertension should be at reduced risk of acute MI and stroke compared with untreated hypertensive POC users.
Obesity
Category
Clarifications/Special considerations
a) > 30 kg/m2 BMI
b) Menarche to < 18 years and ≥30 kg/m2 BMI
Pelvic infection
Category
Clarifications/Special considerations
Current purulent cervicitis or chlamydial infection or gonorrhoea/Pelvic inflammatory disease/Sepsis
1
Tuberculosis
Category
Clarifications/Special considerations
a) Non-pelvic
1
Clarification: If a woman is taking rifampicin, refer to the last section of this table, on Drug Interaction
b) Pelvic
1
Venous thromboembolism
Category
Clarifications/Special considerations
a) History of DVT/PE
2
b) Acute DVT/PE
3
c) DVT/PE and established on anticoagulant therapy
2
d) Family history (first-degree relatives)
1
Drug Interactions:
No drug interactions were selected using the "Women’s characteristics" filters.
Anticonvulsants
Category
Clarifications/Special considerations
a) Certain anticonvulsants,(phenytoin, carbamazepine, barbiturates, primidone, topiramate, oxcarbazepine)
DMPA=1 NET-EN=2
Clarification: Although the interaction of certain anticonvulsants NET-EN is not harmful to women, it is likely to reduce the effectiveness of NET-EN. Read More
b) Lamotrigine
1
Anticonvulsants
Clarification: Although the interaction of certain anticonvulsants NET-EN is not harmful to women, it is likely to reduce the effectiveness of NET-EN. Use of other contraceptives should be encouraged for women who are long-term users of any of these drugs. Use of DMPA is Category 1 because its effectiveness is not decreased by the use of certain anticonvulsants.
Antimicrobial Therapy
Category
Clarifications/Special considerations
a) Broad-spectrum antibiotics
1
b) Antifungals
1
c) Antiparasitics
1
Rifampin/rifabutin
DMPA=1
NET-EN=2
Antiretroviral Therapy
Category
Clarifications/Special considerations
a) Nucleoside reverse transcriptase inhibitors (NRTIs)
Clarification: Antiretroviral drugs have the potential to either decrease or increase the levels of steroid hormones in women using hormonal contraceptives. Read More
Abacavir (ABC)
1
Tenofovir (TDF)
1
Zidovudine (AZT)
1
Lamivudine (3TC)
1
Didanosine (DDI)
1
Emtricitabine (FTC)
1
Stavudine (D4T)
1
b) Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
Efavirenz (EFV)
Etravirine (ETR)
DMPA=1 NET-EN=2
Nevirapine (NVP)
1
Rilpivirine (RPV)
DMPA=1 NET-EN=2
c) Protease inhibitors (PIs)
Ritonavir-boosted atazanavir (ATV/r)
Ritonavir-boosted lopinavir (LPV/r)
DMPA=1 NET-EN=2
Ritonavir-boosted darunavir (DRV/r)
DMPA=1 NET-EN=2
Ritonavir (RTV)
DMPA=1 NET-EN=2
d) Integrase inhibitors
Raltegravir (RAL)
DMPA=1 NET-EN=2
Antiretroviral therapy
Clarification: Antiretroviral drugs have the potential to either decrease or increase the levels of steroid hormones in women using hormonal contraceptives. Pharmacokinetic data suggest potential drug interactions between some antiretroviral drugs (particularly some NNRTIs and ritonavir-boosted PIs) and some hormonal contraceptives. These interactions may reduce the effectiveness of the hormonal contraceptive.
Available studies on the association between progestogen-only injectable contraception and HIV acquisition have important methodological limitations hindering their interpretation. Some studies suggest that women using progestogen-only injectable contraception may be at increased risk of HIV acquisition; other studies have not found this association. The public health impact of any such association would depend upon the local context, including rates of injectable contraceptive use, maternal mortality, and HIV prevalence. This must be considered when adapting guidelines to local contexts. WHO expert groups continue to actively monitor any emerging evidence. At the meeting in 2014, as at the 2012 technical consultation, it was agreed that the epidemiological data did not warrant a change to the MEC. Given the importance of this issue, women at high risk of HIV infection should be informed that progestogen-only injectables may or may not increase their risk of HIV acquisition. Women and couples at high risk of HIV acquisition considering progestogen-only injectables should also be informed about and have access to HIV preventive measures, including male and female condoms.
Other:
No other conditions were selected using the "Women’s characteristics" filters.
Adolescents
Category
Clarifications/Special considerations
Adolescents
2
Special consideration: Adolescents, In general, adolescents are eligible to use any method of contraception and must have access to a variety of contraceptive choices. Read More
Adolescents
Special consideration:
Adolescents, In general, adolescents are eligible to use any method of contraception and must have access to a variety of contraceptive choices. Age alone does not constitute a medical reason for denying any method to adolescents. While some concerns have been expressed regarding the use of certain contraceptive methods in adolescents (e.g. the use of progestogen-only injectables by those below 18 years), these concerns must be balanced against the advantages of avoiding pregnancy. It is clear that many of the same eligibility criteria that apply to older clients apply to young people. However, some conditions (e.g. cardiovascular disorders) that may limit use of some methods in older women do not generally affect young people since these conditions are rare in this age group. Social and behavioural issues should be important considerations in the choice of contraceptive methods by adolescents. For example, in some settings, adolescents are also at increased risk for STIs, including HIV. While adolescents may choose to use any one of the contraceptive methods available in their communities, in some cases, using methods that do not require a daily regimen may be more appropriate. Adolescents, married or unmarried, have also been shown to be less tolerant of side-effects and therefore have high discontinuation rates. Method choice may also be influenced by factors such as sporadic patterns of intercourse and the need to conceal sexual activity and contraceptive use. For instance, sexually active adolescents who are unmarried have very different needs from those who are married and want to postpone, space or limit pregnancy. Expanding the number of method choices offered can lead to improved satisfaction, increased acceptance and increased prevalence of contraceptive use. Proper education and counselling both before and at the time of method selection can help adolescents address their specific problems and make informed and voluntary decisions. Every effort should be made to prevent service and method cost from limiting the options available.
Adolescents
Category
Clarifications / Special Considerations
Adolescents
2
Smoking
Category
Clarifications/Special considerations
a) Age < 35 years
1
b) Age > 35 years
i) < 15 cigarettes/day
1
ii) > 15 cigarettes/day
1
Note: Some methods are unavailable for specific time ranges