March 2015

In 2010, the Centers for Disease Control and Prevention (CDC) released the US Medical Eligibility Criteria for Contraceptive Use (US MEC), which provides guidance for healthcare providers on the safe use of contraceptive methods for patients with medical conditions or other characteristics. For example, there are recommendations on whether women with hypertension can use the pill and whether teenagers can use an intrauterine device (IUD). This guidance was adapted from the World Health Organization, and the recommendations are intended to serve as a source of clinical guidance to providers as they counsel their patients about choosing a contraceptive method; health-care providers should always consider the individual circumstances of each individual seeking family planning services.

The US MEC provides clinical guidance for safe use of contraceptive methods by women and men with various characteristics and medical conditions, with over 1800 recommendations pertaining to more than 60 conditions. CDC has developed several user-friendly tools to help providers access this guidance in the clinic setting.  One popular tool is the US MEC wheel, which is similar to a pregnancy gestation wheel, but provides a subset of recommendations from the US MEC for many of the medical conditions and contraceptive methods.  The medical conditions and patient characteristics are listed around the outside of the wheel and the contraceptive methods are included on an inner wheel.  As the provider spins the inner wheel, a window reveals the recommendation for the specific medical condition and contraceptive method combination.  The back of the wheel contains important additional information to the recommendations, as well as a list of conditions for which all methods can be used.

As an example, your patient is a healthy, 24-year-old woman, who just delivered her first infant 2 weeks ago.  She had used combined oral contraceptives before her pregnancy, and would like to start using them again.  You use the wheel to find the condition of < 21 days postpartum, and see that combined oral contraceptives are a Category 4, meaning that there is an unacceptable health risk for this woman to use combined oral contraceptives.  However, progestin-only methods, including the implant, injection, and pills, are all Category 2, meaning that the advantages of using any of these methods outweigh the risks.  Copper and levonorgestel IUDs are a Category 1 (no restriction) or Category 2.  The information on the wheel is meant to be a useful provider tool; more information, including the full set of recommendations and the evidence for these recommendations can be found in the full US MEC document.  For example, in that document, you would find that the reason for the Category 4 recommendation for combined oral contraceptives for a women < 21 days postpartum is due to evidence regarding increased risk of venous thromboembolism in the postpartum period. the inner wheel, a window reveals the recommendation for the specific medical condition and contraceptive method combination.  The back of the wheel contains important additional information to the recommendations, as well as a list of conditions for which all methods can be used. 

The full US MEC, plus other guidance documents (including the US Selected Practice Recommendations for Contraceptive Use and Providing Quality Family Planning Services), provider tools, videos, and training  and continuing education resources, can be found at: http://www.cdc.gov/reproductivehealth/UnintendedPregnancy/Contraception_Guidance.htm

Please request the “US Medical Eligibility Criteria for Contraceptive Use (MEC) Wheel” at: http://wwwn.cdc.gov/dcs/RequestForm.aspx. You can also download a US MEC app for iPhone or iPad through iTunes.

— Deborah Kowal, MA, PA, President & CEO, Contraceptive Technology Communications, Inc.