Update on the contraceptive contraindications

Abstract

Background: The choice of contraceptive methods has considerably increased over recent years. However, all available methods are not appropriate for all women, especially those with medical conditions or individual characteristics in whom any pregnancy, particularly unintended pregnancy, is at higher risk. The safety of contraception is crucial for these women and evidence-based guidance to help healthcare providers choosing a suitable method has been published. The aim of our review is to make an update on the main contraceptive contraindications.

Methods: The World Health Organisation Medical Eligibility Criteria for Contraceptive Use (WHO-MEC) published in 2015 are referred to throughout this review. The rationale behind the recommendations for women with cardiovascular, rheumatic, neurologic, gynaecological or endocrine disorders was first analysed. The national adaptations of the WHO-MEC, especially the French, British, and American ones, were then scrutinized.

Main findings: Overall, the MECs considered tend to provide the same recommendations. However, there are some noticeable differences that may be useful to know. Hence, for a given condition, differences in categorisation have been noticed where limited or controversial scientific evidence relating to this condition exists, especially regarding hormonal contraceptives. Some medical conditions or characteristics, included in some MECs but not in others, have also been identified.

Conclusion: MECs represent valuable tools to help clinicians to prescribe the most acceptable and safe contraceptive method for each individual woman. Although it may be useful to consult different MECs for some complex conditions, prescribers should always bear in mind that these MECs are only guidelines and that their clinical judgment should always prevail.

Keywords: Contraception; Contraindications; Medical eligibility criteria.