FIGURE 38-1 Intrauterine devices (IUDs). A.ParaGard T 380A copper IUD. B. Mirena levonorgestrel-releasing intrauterine system. (Reproduced with permission from Stuart GS: Contraception and sterilization. In Hoffman BL, Schorge JO, Bradshaw KD, et al: Williams Gynecology, 3rd ed. New York, McGraw-Hili Education, 201o6.)
TABLE 38-2. Contraindications and Cautions with Specific Contraceptive Methods
In this table, a blank space indicates the method is category 1 or 2
Smoking & age ::35 yr 3/4c
Active breast cancer 4 4 4 4 4 Breast disease free ::5 yr 3 3 3 3
Systolic BP ::160 or diastolic BP ::100 4 3
Surgery with long immobilization 4
MS with immobilization 3
DM with end-organ disease 3/4d 3
Cirrhosis (severe, decompensated) 4 3 3 3 3 Liver tumors9 4 3 3 3 3 iStartlContinue (S/C).
Current r history of ISHD 4 2/3 3 2/3 2/3 Stroke 4 2/3 3 2/3
Migraine with aura 4 2/3 2/3 2/3 2/3 Unexplained vaginal bleedingl 3 3 4/2 4/2 aCombination hormone contraception (CHC) group includes pills, vaginal ring, and patch.
bAssociated risks that increase category score include: age :35, transfusion at delivery, BMI :30, postpartum hemorrhage, cesarean delivery, smoking, preeclampsia.
(Smoking : 15 cigarettes/day increases risk category to 4 in this age group.
dRisk category score is modified by associated risk factors and disease severity.
elncluding superficial thrombosis. fOral agents only. Ring and patch are category 1.
gBenign hepatic adenoma or hepatocellular cancer. Focal nodular hyperplasia compatible with hormone use.
hThese include phenytoin, barbiturates, carbamazepine, oxcarbazepine, primidone, topiramate.
lin those methods under Start/Continue columns, the first US MEC number refers to whether a method may be initiated in an afected patient. For patients who initially develop the condition while using a specific method, the second number refers to risks for continuing that method.
JPrior to evaluation.
kThose on chronic corticosteroids and at risk for bone fracture.
= antiretroviral; BP = blood pressure; BMI = body mass index; CHTN = chronic hypertension; Cu-IUD = copper intrauterine device; DM = diabetes mellitus; DMPA = depot medroxyprogesterone acetate; GC/CT = gonorrhea/chlamydial infection; GTD = gestational trophoblastic disease; ISHD = ischemic heart disease; LNG-IUS = levonorgestrel-releasing intrauterine system; MS = multiple sclerosis; PI = protease inhibitor; PID = pelvic inflammatory disease; POP = progestin-only pills; SLE = system lupus erythematosus; VTE = venous thromboembolism. Compiled from Curtis, 2016b; Merck, 2015; Teva Women's Health, 2014.