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Practice Guideline
. 2024 Aug 8;73(3):1-77.
doi: 10.15585/mmwr.rr7303a1.

U.S. Selected Practice Recommendations for Contraceptive Use, 2024

Kathryn M Curtis  1 , Antoinette T Nguyen  1 , Naomi K Tepper  1 , Lauren B Zapata  1 , Emily M Snyder  1 , Kendra Hatfield-Timajchy  1 , Katherine Kortsmit  1 , Megan A Cohen  1 , Maura K Whiteman  1 ; Contributors
Collaborators, Affiliations
Practice Guideline

U.S. Selected Practice Recommendations for Contraceptive Use, 2024

Kathryn M Curtis et al. MMWR Recomm Rep. .

Abstract

The 2024 U.S. Selected Practice Recommendations for Contraceptive Use (U.S. SPR) addresses a selected group of common, yet sometimes complex, issues regarding initiation and use of specific contraceptive methods. These recommendations for health care providers were updated by CDC after review of the scientific evidence and a meeting with national experts in Atlanta, Georgia, during January 25-27, 2023. The information in this report replaces the 2016 U.S. SPR (CDC. U.S. Selected Practice Recommendations for Contraceptive Use, 2016. MMWR 2016;65[No. RR-4]:1-66). Notable updates include 1) updated recommendations for provision of medications for intrauterine device placement, 2) updated recommendations for bleeding irregularities during implant use, 3) new recommendations for testosterone use and risk for pregnancy, and 4) new recommendations for self-administration of injectable contraception. The recommendations in this report are intended to serve as a source of evidence-based clinical practice guidance for health care providers. The goals of these recommendations are to remove unnecessary medical barriers to accessing and using contraception and to support the provision of person-centered contraceptive counseling and services in a noncoercive manner. Health care providers should always consider the individual clinical circumstances of each person seeking contraceptive services. This report is not intended to be a substitute for professional medical advice for individual patients; when needed, patients should seek advice from their health care providers about contraceptive use.

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Conflict of interest statement

All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed. To promote transparency, all meeting participants were asked to disclose potential conflicts of interest to CDC before the expert meeting and to report potential conflicts of interest during the introductory portion of the expert meeting. All potential conflicts of interest disclosed by meeting participants are listed. No participants were excluded from discussion based on potential conflicts of interest. CDC staff members who ultimately decided and developed these recommendations have no financial interests or other relationships with the manufacturers of commercial products, suppliers of commercial services, or commercial supporters relevant to these recommendations.

Figures

FIGURE 1
FIGURE 1
Recommended actions after late or missed combined oral contraceptives Abbreviation: UPA = ulipristal acetate.
FIGURE 2
FIGURE 2
Recommended actions after delayed application or detachment with combined hormonal patch Abbreviation: UPA = ulipristal acetate. * If detachment takes place but the patient is unsure when the detachment occurred, consider the patch to have been detached for ≥48 hours since a patch should have been applied or reattached.
FIGURE 3
FIGURE 3
Recommended actions after delayed placement or replacement with combined vaginal ring (etonogestrel/ethinyl estradiol)† Abbreviation: UPA = ulipristal acetate. * If removal takes place but the patient is unsure when the ring was removed, consider the ring to have been removed for ≥48 hours since a ring should have been placed or replaced. † These recommendations are based on evidence for the etonogestrel/ethinyl estradiol combined vaginal ring. For dosing errors with the segesterone acetate/ethinyl estradiol vaginal ring, please see the package label.
FIGURE 4
FIGURE 4
Recommended actions after vomiting or diarrhea while using combined oral contraceptives Abbreviation: UPA = ulipristal acetate.
FIGURE 5
FIGURE 5
Recommended actions after late or missed progestin-only pills Abbreviations: POP = progestin-only pill; UPA = ulipristal acetate.
FIGURE E1
FIGURE E1
Management of bleeding irregularities while using contraception Abbreviations: CHC = combined hormonal contraceptive; COC = combined oral contraceptive; Cu-IUD = copper intrauterine device; DMPA = depot medroxyprogesterone acetate; EE = ethinyl estradiol; LNG-IUD = levonorgestrel intrauterine device; NSAID = nonsteroidal anti-inflammatory drug; SERM = selective estrogen receptor modulator. * If clinically indicated, consider an underlying health condition, such as interactions with other medications, sexually transmitted infections, pregnancy, thyroid disorders, or new pathologic uterine conditions (e.g., polyps or fibroids). If an underlying health condition is found, treat the condition or refer for care.
FIGURE F1
FIGURE F1
Management of intrauterine devices when users of copper intrauterine devices or levonorgestrel intrauterine devices are found to have pelvic inflammatory disease Abbreviations: IUD = intrauterine device; PID = pelvic inflammatory disease. * Refer to CDC Sexually Transmitted Infections Treatment Guidelines (https://www.cdc.gov/std/treatment-guidelines/default.htm) for information on PID diagnostic considerations and treatment regimens.
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References

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    1. Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. MMWR Recomm Rep 2021;70(No. RR-4):1–187. 10.15585/mmwr.rr7004a1 - DOI - PMC - PubMed
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