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This bulletin is being sent by the Health Care Authority (HCA) in partnership with the Reproductive Health Access Project (RHAP).
RHAP has finished updating the Medical Eligibility Criteria for Initiating Contraception based on the 2024 CDC Medical Eligibility Criteria (MEC) and Selected Practice Recommendations (SPR) for Contraceptive Use. This is a reference tool for clinicians who want to check a patient’s medical eligibility for initiating various forms of contraception as they relate to absolute and relative contraindications. Updates include new recommendations for:
- Breastfeeding
- Postpartum
- Postabortion
- Obesity
- Major surgery
- Deep venous thrombosis or pulmonary embolism with or without anticoagulant therapy
- Thrombophilia
- Superficial venous thrombosis
- Valvular heart disease
- Peripartum cardiomyopathy
- Systemic lupus erythematosus
- Cirrhosis
- Liver tumor
- Sickle cell disease
- Solid organ transplantation
See Appendix A
Notable updates
- Recommendations on contraceptive use among people with chronic kidney disease on dialysis or with nephrotic syndrome.
- Modified or re-categorized conditions and characteristics, like postabortion, surgery, deep vein thrombosis or pulmonary embolism.
- Hormonal contraceptive use for people with sickle cell disease was increased from a MEC category 2 to category 4, reflecting thrombosis risk.
- Accounting for new formulations of contraceptive methods, like the drospirenone progestin-only pill and vaginal pH modulator.
Notable changes to the SPR to enhance contraceptive care
Expanded pain relief options during IUD placement
- The SPR emphasizes that all patients should be counseled about potential pain during IUD insertion. It recommends developing a person-centered plan for pain management and includes topical analgesics like lidocaine gels, creams, or sprays. Misoprostol is not recommended for routine use for IUD placement.
Expanded treatment options to manage bleeding irregularities with contraceptive implants
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Recommendations include the use of antifibrinolytic agents, such as tranexamic acid, and selective estrogen receptor modulators (SERMS, e.g. tamoxifen).
Importance of unbiased, patient-centered contraceptive counseling and care for transgender and gender-expansive individuals using testosterone who may still be at risk for pregnancy
Support for self-administration of injectable contraception
- Subcutaneous depot medroxyprogesterone acetate (DMPA-SC) should be made available for self-administration. Increasing access to self-injectable contraception can empower people to manage their contraceptive needs on their own terms.
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Review the September 2024 Contraceptive Pearl, Updated CDC Contraception Guidelines, and the resources below.
At the time of this publication, the CDC has reinstated the 2024 MEC and SPR to its website without any edits. On our resource page, find links to downloadable PDFs of these guidelines, reference charts, and appendices.
Find saved clinical guidelines, reports, and datasets on family planning, sexual health, vaccine schedules, youth health care, LGBTQI+ care, and more:
RHAP resources
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About HCA and RHAP partnership
HCA has partnered with RHAP to support the reproductive health provider community’s access to accurate, evidence-based clinical information. If you are an enrolled Apple Health (Medicaid) provider, HCA will pay for bulk print items from the RHAP resource library. To order, email Brandy Bautista with "Washington Health Care Authority" in the body of the email, the items you'd like to order, quantities, business address, and delivery address (if different than your business address).
Email Andrea Estes, Sexual and Reproductive Health Programs Innovation Manager at HCA, with questions regarding this partnership.
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