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Family Planning

Training Resource Package

Summary of
Updates in the
WHO Medical
eligibility criteria for
contraceptive use,
Fifth edition, 2015

Slide 1
Medical Eligibility Criteria
for Contraceptive Use
• Offers evidence-based recommendations on
contraceptive eligibility in the presence of
medical conditions and client characteristics
• Covers 20 contraceptive methods
• Fifth edition included review of fourteen topics
(encompassing over 575 recommendations)
– In many instances, either no new evidence was
identified, or emerging evidence confirmed previous
findings.
– Therefore, relevant recommendations in 4th
edition were reviewed and upheld.
Slide 2
MEC 2015 Executive Summary

• Presents the summaries


of key recommendations
about the updates.
• May be downloaded at:
http://www.who.int/reprod
uctivehealth/publications/f
amily_planning/Ex-Summ-
MEC-5/en/

Slide 3
MEC wheel 2015 update

• Based on the MEC, provides


quick information on who can
use methods
– Includes COCs, POPs, DMPA,
NET-EN (IM&SQ), implants, and
copper IUDs, LNG-IUD, combined
injectable contraceptives, patch,
vaginal ring
• Available in print version, may
also be downloaded:
– http://www.who.int/reproductivehe
alth/publications/family_planning/
mec-wheel-5th/en/

Slide 4
Other WHO FP Cornerstones

• Selected Practices Recommendations


for contraceptive use
– Range of issues including initiation,
continuation, incorrect use, treatment of side
effects, and some programmatic issues
– Being updated, will be available in late 2015

• Family Planning: A Global Handbook


for Providers
– Essentials needed by clinical providers to
provide quality care
– Present guidance for delivering contraceptive
methods appropriately and effectively
– Update underway Slide 5
MEC Categories

Where warranted, recommendations will differ if a woman is starting a method (I = initiation) or


continuing a method (C = continuation)

Slide 6
MEC 5th Edition
New methods added

• Subcutaneously-administered depot
medroxyprogesterone acetate (DMPA-SC)
– Generally follow recommendations for DMPA-IM
• Sino-Implant (II) ƒ
– Generally will follow recommendations for LNG implants
• Progesterone-releasing vaginal ring
– For use by women who are actively breastfeeding and are ≥ 4
weeks postpartum without restrictions (MEC Category 1)
• U
ƒ lipristal acetate (UPA) as emergency contraception
– With specific recommendations for breastfeeding women
(MEC Category 2)

Slide 7
MEC 5th Edition
Specific Topics Reviewed
• Combined hormonal contraceptive use (CHC) by age group,
breastfeeding women, postpartum women, women with superficial
venous disorders and with known dyslipidaemias.
• Progestogen-only contraceptive (POC) and levonorgestrel-releasing
intrauterine device (LNG-IUD) use among breastfeeding women.
• IUD use for women with increased risk of sexually transmitted
infections (STIs)
• Use of CYP3A4 inducers and obesity as new conditions for ECP
use
• ƒ
Hormonal contraception for women at high risk of HIV infection,
women living with HIV, and women living with HIV using
antiretroviral therapy (ART)

Slide 8
MEC 5th Edition
Recommendations on specific topics
Combined hormonal contraceptive use (CHC)
• Age group
• Without restriction from menarche to 40 years (MEC 1)
• 40 years and older can generally use (MEC 2)
• Breastfeeding women and post partum women
• Should not use CHCs if less than 6 weeks post partum
(MEC 4)
• ≥ 6 weeks to < 6 months postpartum generally should not
use CHCs (MEC 3).
• ≥ 6 months postpartum can generally use CHCs (MEC 2).

Slide 9
MEC 5th Edition
Recommendations on specific topics
Combined hormonal contraceptive use (CHC)
• Women with superficial venous disorders
• New terminology used (formerly superficial
thrombophlebitis)
• Women with known dyslipidaemias
• New terminology used (formerly known hyperlipidaemia),
and to include only women without other known
cardiovascular risk factors
• Can generally use CHCs (note with clarifications in main
document)

Slide 10
MEC 5th Edition
Recommendations on specific topics
• Progestogen-only contraceptive (POC) and
levonorgestrel-releasing intrauterine device
(LNG-IUD) use among breastfeeding women.
– Implants (LNG, ETG) and progestogen-
only pills (POPs) can now be offered in
the immediate postpartum period.
– LNG-IUD can be immediately inserted in
first 48 hours.

Slide 11
MEC 5th Edition
Recommendations on specific topics
• Copper-bearing IUD (Cu-IUD) or LNG-IUD use
for women with increased risk of sexually
transmitted infections (STIs)
– Initiation - Many women with increased risk of
STIs can generally undergo IUD initiation (MEC
Category 2); unless with a very high individual
likelihood of STIs in which they generally should
not have an IUD inserted until appropriate testing
and treatment occur (MEC Category 3).
– Continuation - Women at increased risk of STIs can
generally continue use of either Cu-IUD or LNG-IUD
(MEC Category 2).
Slide 12
MEC 5th Edition
Recommendations on specific topics
• Use of CYP3A4 inducers and obesity as new
conditions for ECP use
– For these conditions, ECP using COC, LNG or UPA
are in Category 1.
– CYP3A4 inducers include rifampicin, phenytoin,
phenobarbital, carbamazepine, efavirenz,
fosphenytoin, nevirapine, oxcarbazepine, primidone,
rifabutin, St John’s wort/ Hypericum perforatum

Slide 13
ƒ
Hormonal contraception for women at high risk of HIV
infection, and women living with HIV

• For women at high risk of HIV or living with


HIV, WHO recommends no restrictions for:
– Combined hormonal contraceptives or
progestogen-only contraceptives

– Women and couples at high risk of HIV infection


& using POIs should be informed about (and
have access to) HIV preventative measures,
including male and female condoms.

– LNG –IUDs can generally be used; however,


initiation should be generally avoided if
advanced/severe disease

Slide 14
Filename
ƒ
Hormonal contraception for women living with HIV
using antiretroviral therapy (ART)

• For women taking ART, WHO recommends


they are generally eligible to use hormonal
contraception:
– Special consideration for efavirenz or neviripine &
some protease inhibitors may be warranted.
• Consistent and correct use of condoms, male
or female, is critical to protect against
STIs/HIV and for prevention of HIV
transmission

Slide 15
Filename
MEC 5th Edition
Recommendations
• Details of the
recommendations on
the methods are
available in the full
MEC 5th edition
document.
• http://www.who.int/rep
roductivehealth/public
ations/family_plannin
g/MEC-5/en/

Slide 16

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