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More clinicians put US MEC into practice
Are you implementing guidance from the US Medical Eligibility Criteria for Contraceptive Use, 2010, (US MEC) released by the Centers for Disease Control and Prevention (CDC)?1 The American College of Obstetricians and Gynecologists (ACOG) has just issued a Committee Opinion on the guidelines to help clinicians provide family planning services to women, especially those with medical conditions.2
ACOG decided to publish the Committee Opinion to publicize the "extremely useful" evidence-based recommendations originally developed by the World Health Organization, but they were adapted specifically for use in the United States by the CDC, says Eve Espey, MD, MPH, professor in the Department of Obstetrics and Gynecology in the School of Medicine at the University of New Mexico.
"The 4-[category] rating US MEC recommendations are in a format that is easy for clinicians to understand and use as a reference for the many contraceptive scenarios they face on a daily basis," explains Espey, chair of ACOG's Long-Acting Reversible Contraception Work Group and a co-developer of the bulletin.
The CDC MEC guidelines provide a sound, evidence-based document that when used on a national basis, will provide consistently high-level contraceptive care, says Sharon Schnare, FAANP, clinical instructor in the Department of Family and Child Nursing at the University of Washington School of Nursing in Seattle.
Put it into practice
The US MEC contains combinations of medical conditions and contraceptive methods that are rated on a scale of 1 to 4 in terms of safety. Category 1 indicates there are no restrictions for use of the method, while category 4 indicates the method could present an unacceptable health risk for the patient. (See box item, below, for an explanation of the four categories.)
US Medical Eligibility Criteria for Contraceptive Use
Source: Centers for Disease Control and Prevention. U S. medical eligibility criteria for contraceptive use, 2010. MMWR Recomm Rep 2010; 59(RR-4):1-86.
More than 65 medical conditions and characteristics, from women's cancers and chronic diseases to breastfeeding and smoking, with additional sub-conditions, are covered in the US MEC. Consider women who smoke: Use of combined oral contraceptives (OCs) in a woman age 35 or older who smokes 15 or more cigarettes per day is considered a Category 4 due to the risk of myocardial infarction and stroke. Use of combined pills in a woman who is the same age, but smokes fewer than 15 cigarettes per day, is classified as Category 3 and generally is not recommended unless other methods are unavailable or unacceptable to her. Use of combined OCs is classified as Category 2 for smokers younger than 35.2
Women with certain medical conditions are at higher risk for adverse outcomes with an unintended pregnancy, and these recommendations can assist clinicians in helping patients choose the most appropriate contraceptive method, notes Espey. These conditions include endometrial cancer, epilepsy, history of bariatric surgery, ovarian cancer, peripartum cardiomyopathy, solid organ transplantation, stroke, systemic lupus erythematosus, thrombogenic mutations, and tuberculosis. They are marked with an asterisk in the Committee Opinion.
Check chronic conditions
Most patients can choose from an array of available contraceptive methods without substantial concerns about the safety of the method. However, for women with chronic medical conditions, questions can arise regarding contraceptive safety, notes Emily Godfrey, MD, MPH, assistant professor of family medicine at the University of Illinois at Chicago College of Medicine.
For example, the use of combined hormonal contraceptives by women with known thrombogenic mutations has been shown to carry unacceptable risks of venous thromboembolism, observes Godfrey, who presented information on the US MEC at the recent Reproductive Health 2011 conference.3
The US MEC contains recommendations for the safe use of contraceptive methods by women and men with various characteristics and medical conditions and is intended to assist healthcare providers when counseling patients about contraceptive method choice, explains Godfrey. In collaboration with the World Health Organization, the CDC regularly identifies new relevant, scientific evidence as it is published and updates the guidance as needed.
While it is intended that the US MEC will become the primary reference for clinicians to assist patients with making safe contraceptive choices, the guidance is just one element that needs to be considered by the provider and the patient when choosing the most appropriate method, Godfrey notes. Other important elements providers should consider are effectiveness, availability, and acceptability.
"Hopefully, clinicians who follow the US MEC guidance when treating patients with chronic medical conditions will better counsel patients regarding safe contraceptive choices, including restricting use when there is evidence of risk, but also facilitating use where there is evidence of safety," states Godfrey.