New CDC "Medical Eligibility" Tables (Contraceptive Use)

New CDC "Medical Eligibility" Tables (Contraceptive Use)

Postby PharmD » Thu Dec 02, 2010 5:21 pm

The United States Centers for Disease Control (CDC) modified the World Health Organization (WHO) tables for medical eligibility criteria for contraceptive use. Selected WHO recommendations were adapted for US clinicians and patients, the number of medical conditions was expanded and recommendations added, and contraceptive methods not available in the US were removed.
U.S. Medical Eligibility Criteria for Contraceptive Use, 2010 - Adapted from the World Health Organization Medical Eligibility Criteria for Contraceptive Use, 4th edition. Available at http://www.cdc.gov/mmwr/preview/mmwrhtm ... 0528a1.htm (Accessed December 2, 2010).

TABLE 1. Percentage of women experiencing an unintended pregnancy during the first year of typical use and the first year of perfect use of contraception and the percentage continuing use at the end of the first year --- United States

Method
Women experiencing an unintended pregnancy within the first year of use
Women continuing use at 1 year§

Typical use*
Perfect use†

No method¶
85%
85%

Spermicides**
29%
18%
42%

Withdrawal
27%
4%
43%

Fertility awareness--based methods
25%
51%

Standard Days method††
5%

TwoDay method(tm)††
4%

Ovulation method††
3%

Sponge

Parous women
32%
20%
46%

Nulliparous women
16%
9%
57%

Diaphragm§§
16%
6%
57%

Condom¶¶

Female (Reality(r))
21%
5%
49%

Male
15%
2%
53%

Combined pill and progestin-only pill
8%
0.3%
68%

Evra patch(r)
8%
0.3%
68%

NuvaRing(r)
8%
0.3%
68%

Depo-Provera(r)
3%
0.3%
56%

Intrauterine device

ParaGard(r) (copper T)
0.8%
0.6%
78%

Mirena(r) (LNG-IUS)
0.2%
0.2%
80%

Implanon(r)
0.05%
0.05%
84%

Female sterilization
0.5%
0.5%
100%

Male sterilization
0.15%
0.10%
100%

Emergency contraceptive pills***
Not applicable
Not applicable
Not applicable

Lactational amenorrhea methods†††
Not applicable
Not applicable
Not applicable

Adapted from Trussell J. Contraceptive efficacy. In Hatcher RA, Trussell J, Nelson AL, Cates W, Stewart FH, Kowal D. Contraceptive technology. 19th revised ed. New York, NY: Ardent Media; 2007.

* Among typical couples who initiate use of a method (not necessarily for the first time), the percentage who experience an unintended pregnancy during the first year if they do not stop use for any other reason. Estimates of the probability of pregnancy during the first year of typical use for spermicides, withdrawal, fertility awareness-based methods, the diaphragm, the male condom, the pill, and Depo-Provera are taken from the 1995 National Survey of Family Growth corrected for underreporting of abortion; see the text for the derivation of estimates for the other methods.

† Among couples who initiate use of a method (not necessarily for the first time) and who use it perfectly (both consistently and correctly), the percentage who experience an unintended pregnancy during the first year if they do not stop use for any other reason. See the text for the derivation of the estimate for each method.

§ Among couples attempting to avoid pregnancy, the percentage who continue to use a method for 1 year.

¶ The percentages becoming pregnant in the typical use and perfect use columns are based on data from populations where contraception is not used and from women who cease using contraception to become pregnant. Of these, approximately 89% become pregnant within 1 year. This estimate was lowered slightly (to 85%) to represent the percentage who would become pregnant within 1 year among women now relying on reversible methods of contraception if they abandoned contraception altogether.

** Foams, creams, gels, vaginal suppositories, and vaginal film.

†† The TwoDay and Ovulation methods are based on evaluation of cervical mucus. The Standard Days method avoids intercourse on cycle days 8--19.

§§ With spermicidal cream or jelly.

¶¶ Without spermicides.

*** Treatment initiated within 72 hours after unprotected intercourse reduces the risk for pregnancy by at least 75%. The treatment schedule is 1 dose within 120 hours after unprotected intercourse and a second dose 12 hours after the first dose. Both doses of Plan B can be taken at the same time. Plan B (1 dose is 1 white pill) is the only dedicated product specifically marketed for emergency contraception. The Food and Drug Administration has in addition declared the following 22 brands of oral contraceptives to be safe and effective for emergency contraception: Ogestrel or Ovral (1 dose is 2 white pills); Levlen or Nordette (1 dose is 4 light-orange pills); Cryselle, Levora, Low-Ogestrel, Lo/Ovral, or Quasence (1 dose is 4 white pills); Tri-Levlen or Triphasil (1 dose is 4 yellow pills); Jolessa, Portia, Seasonale, or Trivora (1 dose is 4 pink pills); Seasonique (1 dose is 4 light blue-green pills); Empresse (1 dose is 4 orange pills); Alesse, Lessina, or Levlite (1 dose is 5 pink pills); Aviane (1 dose is 5 orange pills); and Lutera (1 dose is 5 white pills).

††† Lactational amenorrhea method is a highly effective temporary method of contraception. However, to maintain effective protection against pregnancy, another method of contraception must be used as soon as menstruation resumes, the frequency or duration of breastfeeding is reduced, bottle feeds are introduced, or the baby reaches 6 months of age.
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