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WHO medical eligibility criteria wheel for contraceptive use 2015 update.

MEDICAL ELIGIBILITY CRITERIA WHEEL

FOR CONTRACEPTIVE USE

1.Contraception - methods. 2.Family Planning Services - methods. 3.Eligibility Determination - standards.

I.World Health Organization.
(NLM classification: WP 630)

World Health Organization 2015

2015

All rights reserved. Publications of the World Health Organization are available on the WHO website (www.who.int) or can be
purchased from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland
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Requests for permission to reproduce or translate WHO publications whether for sale or for non-commercial distribution
should be addressed to WHO Press through the WHO website (www.who.int/about/licensing/copyright_form/en/index.html).
The designations employed and the presentation of the material in this publication do not imply the expression of any
opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or
area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps
represent approximate border lines for which there may not yet be full agreement.

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All reasonable precautions have been taken by the World Health Organization to verify the information contained in this
publication. However, the published material is being distributed without warranty of any kind, either expressed or implied.
The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health
Organization be liable for damages arising from its use.

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The mention of specific companies or of certain manufacturers products does not imply that they are endorsed or
recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors
and omissions excepted, the names of proprietary products are distinguished by initial capital letters.

ISBN 978 92 4 154925 7

SEPSIS

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ISBN 978 92 4 154925 7

About this wheel

This wheel contains the medical eligibility criteria for starting use of contraceptive methods, based on Medical Eligibility
Criteria for Contraceptive Use, 5th edition (2015), one of WHOs evidence-based guidelines. It guides family planning providers
in recommending safe and effective contraception methods for women with medical conditions or medically-relevant
characteristics.
The wheel includes recommendations on initiating use of nine common types of contraceptive methods:
1.
2.
3.
4.
5.
6.

Combined pills, COC (low dose combined oral contraceptives, with 35 g ethinyl estradiol)
Combined contraceptive patch, P
Combined contraceptive vaginal ring, CVR
Combined injectable contraceptives, CIC
Progestogen-only pills, POP
Progestogen-only injectables, DMPA (IM,SC)/NET-EN (depot medroxyprogesterone acetate intramuscular or subcutaneous
or norethisterone enantate intramuscular)
7. Progestogen-only implants, LNG/ETG (levonorgestrel or etonogestrel)
8. Levonorgestrel-releasing intrauterine device, LNG-IUD
9. Copper-bearing intrauterine device, Cu-IUD

Antiretroviral Medications and Abbreviations on the MEC Wheel

Nucleoside reverse
transcriptase inhibitors (NRTIs)

Non-nucleoside reverse
transcriptase inhibitors (NNRTIs)

Protease inhibitors (PIs)

ABC

Abacavir

EFV

Efavirenz

ATV/r

Ritonavir-boosted atazanavir

TDF

Tenofovir

ETR

Etravirine

LPV/r

Ritonavir-boosted lopinavir

AZT

Zidovudine

NVP

Nevirapine

DRV/r

Ritonavir-boosted darunavir

3TC

Lamivudine

RPV

Rilpirivine

RTV

Ritonavir

DDI

Didanosine

FTC

Emtricitabine

Integrase Inhibitors

D4T

Stavudine

RAL

Raltegravir

Emergency contraceptive pills

Copper IUD for Emergency Contraception (Cu-IUD)

CONDITION

COC

LNG

UPA

Pregnancy

NA

NA

NA

Breastfeeding

Obesity (BMI 30 kg/m )

History of severe
cardiovascular disease
(ischaemic heart disease,
cerebrovascular attack,
or other thromboembolic
conditions)

Migraine

Past ectopic pregnancy

The eligibility criteria for general Cu-IUD insertion

also apply for the insertion of Cu-IUDs as emergency
contraception.

2
2

CONDITION

Cu-IUD

Pregnancy

Rape

Severe liver disease

(including jaundice)

CYP3A4 inducers (e.g.

rifampicin, phenytoin,
phenobarbital,
carbamazepine, efavirenz,
fosphenytoin, nevirapine,
oxcarbazepine, primidone,
rifabutin, St Johns wort/
hypericum perforatum)

Repeated emergency
contraceptive pill use

Rape

COC = combined oral contraceptives; LNG = levonorgestrel;

UPA = ulipristal acetate; NA = not applicable

This method is highly effective for preventing pregnancy.

It can be used within 5 days of unprotected intercourse
as an emergency contraceptive. However, when the
time of ovulation can be estimated, the Cu-IUD can be
inserted beyond 5 days after intercourse, if necessary,
as long as the insertion does not occur more than 5 days
after ovulation.

Emergency contraceptive pills may be less effective among women

with BMI 30 kg/m2 than among women with BMI < 25 kg/m2.
Despite this, there are no safety concerns.

a) High risk of STI

b) Low risk of STI

How to use this wheel

The wheel matches up the contraceptive methods, shown on the inner
disk, with specific medical conditions or characteristics shown around
the outer rim. The numbers shown in the viewing slot tell you whether
the woman who has this known condition or characteristic is able to
start use of the contraceptive method:
CATEGORY

WITH CLINICAL JUDGEMENT

Use method in any circumstance

Generally use method

Use of method not usually

recommended unless other more
appropriate methods are not
available or not acceptable

Method not to be used

WITH LIMITED
CLINICAL JUDGEMENT

YES
(Use the method)

NO
(Do not use the
method)

Categories 1 and 4 are clearly defined recommendations. For categories

2 or 3, greater clinical judgement will be needed and careful follow-up
may be required. If clinical judgement is limited, categories 1 and 2 both
mean the method can be used, and categories 3 and 4 both mean the
method should not be used.
No restrictions for some conditions: there are many medical conditions
when ALL methods can be used (that is, all the methods are either a
category 1 or 2). Some of these conditions are listed on the back of the
wheel.
With few exceptions, all women can safely use emergency
contraception, barrier and behavioral methods of contraception,
including lactational amenorrhea method; for the complete list of
recommendations, please see the full document.
Only correct and consistent use of condoms, male or female,
protect against STI/HIV. If there is a risk of STI/HIV, condom use is
recommended.

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A
B
C
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H
I

If condition develops while using method, can continue using it during treatment.
If very high likelihood of exposure to gonorrhoea or chlamydia =3.
If past pelvic inflammatory disease (PID) all methods =1, including IUDs.
If <3 wks, not breastfeeding & no other VTE risk factors =3.
If not breastfeeding =1.
If 3 to <6 wks, not breastfeeding & no other VTE risk factors =2, with other VTE risk factors =3.

If 6 wks & not breastfeeding =1.

If uterine cavity distorted preventing insertion =4.
Refers to hepatocellular adenoma (benign) or carcinoma/
hepatoma (malignant).
J If adenoma CIC =3, if carcinoma/hepatoma CIC =3/4.
K CIC =3.
L If established on anticoagulation therapy =2.
M If condition developed while on this method, consider
switching to non-hormonal method.
N Risk factors: older age, smoking, diabetes, hypertension,
obesity & known dyslipidaemias.
O If cannot measure blood pressure & no known history
of hypertension, can use all methods. Either systolic or
diastolic blood pressure may be elevated.
P If age <18 yrs & obese DMPA/NET-EN =2.
Q For insulin-dependent & non-insulin-dependent. If
complicated or >20 yrs duration, COC/P/CVR, CIC =3/4;
DMPA, NET-EN =3.

If <15 cigarettes/day CIC =2. If 15 cigarettes/day

COC/P/CVR =4.
S Aura is focal neurological symptoms, such as flickering
lights. If no aura & age <35 COC/P/CVR, CIC =2, POP =1.
If no aura & age 35 COC/P/CVR, CIC =3, POP =1.
T Barbituates, carbamazepine, oxcarbazepine, phenytoin,
primidone, topiramate & lamotrigine.
U If barbituates, carbamazepine, oxcarbazepine, phenytoin,
primidone or topiramate CIC =2.
V If lamotrigine =1.
W DMPA =1, NET-EN =2.
X CICs =2.
Y If antiretroviral therapy with EFV, NVP, ATV/r, LPV/r, DRV/r,
RTV: COC/P/CVR, CIC, POP, NET-ET, Implants =2; DMPA =1.
For all NRTIs, ETR, RPV, RAL each method =1. See jacket
for full names of medications.
Z If WHO Stage 3 or 4 (severe or advanced HIV clinical
disease) IUD =3.

Conditions that are category 1 and 2 for all methods (method can be used)
Reproductive Conditions: Benign breast disease or undiagnosed mass Benign ovarian tumours, including cysts Dysmenorrhoea Endometriosis History
of gestational diabetes History of high blood pressure during pregnancy History of pelvic surgery, including caesarean delivery Irregular, heavy or
prolonged menstrual bleeding (explained) Past ectopic pregnancy Past pelvic inflammatory disease Post-abortion (no sepsis) Postpartum 6 months
Medical Conditions: Depression Epilepsy HIV asymptomatic or mild clinical disease (WHO Stage 1 or 2) Iron-deficiency anaemia, sickle-cell disease
and thalassaemia Malaria Mild cirrhosis Schistosomiasis (bilharzia) Superficial venous disorders, including varicose veins Thyroid disorders
Tuberculosis (non-pelvic) Uncomplicated valvular heart disease Viral hepatitis (carrier or chronic)
Other: Adolescents Breast cancer family history Venous thromboembolism (VTE) family history High risk for HIV
Surgery without prolonged immobilization Taking antibiotics (excluding rifampicin/rifabutin)
With few exceptions, all women can safely use emergency contraception, barrier and behavioural methods of contraception, including
lactational amenorrhoea method; for the complete list of recommendations, please see the full document.
Combined is a combination of ethinyl estradiol & a progestogen.
CIC: combined injectable contraceptive COC: combined oral contraceptive pill
Cu-IUD: copper intrauterine device CVR: combined contraceptive vaginal ring
DMPA (IM, SC): depot medroxyprogesterone acetate, intramuscular or subcutaneous
ETG: etonogestrel LNG: levonorgestrel LNG-IUD: levonorgestrel intrauterine device
NET-EN: norethisterone enanthate P: combined contraceptive patch
POP: progestogen-only pill

Lev
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1 Use the method in any

circumstance

Use of the method not usually

recommended unless other, more
appropriate methods are not
available or acceptable

2 Generally use the method

Method NOT to be used

WHO Medical Eligibility Criteria Wheel

for contraceptive use, 2015
These methods do not protect against STI/HIV. If there is a risk of STI/HIV, the
correct and consistent use of condoms, male or female, is recommended.

Acknowledgements
The Medical Eligibility Criteria for Contraceptive Use and this version of
the Medical Eligibility Criteria Wheel were developed by the Word Health
Organizations Department of Reproductive Health and Research. This
wheel is based upon similar medical eligibility criteria wheels developed
independently in Ghana and Jordan. In particular, we would like to thank
the University of Ghana Medical Schools Department of Obstetrics
and Gynaecology; the Communication Partnership for Family Health
in Jordan; and the Johns Hopkins Bloomberg School of Public Health/
Center for Communications Programs for their innovative work.
Dr Anna Altshuler was responsible for this 2015 edition, in collaboration
with Dr Erin Berry-Bibee, Dr Kathryn Curtis, Dr Monica Dragoman,
DrMary Lyn Gaffield, Dr Tara Jatlaoui, and Ms Halley Riley.
Layout and design: Ms Cath Hamill

Ordering copies and further information

Detailed information on the medical eligibility criteria, including
guidance on other contraceptive methods, appears in the Medical
Eligibility Criteria for Contraceptive Use, 5th edition (2015). This can be
accessed at http://www.who.int/reproductivehealth/en/. Bulk orders
(20 wheels/package) to supply programmes or single orders can be
ordered from: WHO Press, World Health Organization, 1211 Geneva 27,
Switzerland, email: bookorders@who.int. Order online: http://apps.who.
int/bookorders/