Medical Eligibility for Initiating Contraception: Absolute and Relative Contraindications

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
Risk Level  
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-mild

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

See above

See above

6 weeks – 6 months postpartum

3

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

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These forms are not intended to provide legal, medical or other professional advice. They are not a substitute for consultation with a healthcare provider or for independent judgment by healthcare providers or other professionals regarding individual conditions and situations.