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This bulletin is being sent by the Health Care Authority (HCA) in partnership with the Reproductive Health Access Project (RHAP).
On August 6, 2024, the Centers for Disease Control and Prevention (CDC) released updates for the U.S. Medical Eligibility Criteria for Contraceptive Use (U.S. MEC) and the U.S. Selected Practice Recommendations for Contraceptive Use (U.S. SPR). Adapted from guidelines from the World Health Organization, the U.S. MEC and U.S. SPR provide evidence-based recommendations that aim to reduce unnecessary barriers to contraceptive care. This update reflects an important shift in the framing of contraceptive decision-making, calling out the importance of patient autonomy, patient-centeredness, and shared decision-making.
The U.S. MEC provides recommendations for the use of contraceptive methods by people who have certain characteristics or medical conditions, or those using some medications. The format remains unchanged, where the recommendations are reflected in categories 1-4. One new medical condition was added to provide recommendations on the use of contraception among people with chronic kidney disease on dialysis or with nephrotic syndrome. A number of existing conditions or characteristics were modified or re-categorized (e.g. postabortion, surgery, deep vein thrombosis or pulmonary embolism). To reflect new evidence since the last update, some MEC categories were increased (e.g., an MEC 1 was changed to MEC 2) while others were decreased. For many of these changes, depo medroxyprogesterone acetate (DMPA) is a higher MEC category than other progestin-only methods for medical conditions with an increased risk of thrombosis. Another notable change is for sickle cell disease, where combined hormonal contraceptives were increased from an MEC 2 to an MEC 4, also reflecting thrombosis risk. The U.S. MEC was also updated to account for new formulations of methods, including the drospirenone progestin-only pill, as well as new methods such as the vaginal pH modulator. The full list of changes is detailed in Appendix A.
The U.S. SPR provides recommendations for certain potentially complicated issues around the initiation or use of some contraceptive methods. The updated guidance includes new recommendations around the use of testosterone and the risk of pregnancy, highlighting the importance of offering contraceptive counseling and services in an unbiased manner to transgender and gender-expansive patients. Recommendations on medications for IUD placement were updated to include a more comprehensive discussion of the importance of addressing pain with IUD procedures, and expanded options for pain management, including topical analgesics. Guidance around the management of bleeding irregularities with the contraceptive implant was expanded to include antifibrinolytic agents (e.g. tranexamic acid) and selective estrogen receptor modulators (SERMs, e.g. tamoxifen).
Updated provider tools from the CDC reflecting these changes, including an updated chart for the U.S. MEC and an updated bleeding algorithm, can be found on their website. The CDC Contraception app has been updated for the iPhone and Android. Stay tuned for updates from RHAP as we adjust our resources as well!
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