The tables below contain a summarised version of the medical eligibility criteria for initiating a patient on
contraceptive methods, based on the MOH (2016) and WHO (2015) Medical Eligibility Criteria for Contraceptive Use. It guides family planning providers in recommending safe and effective contraception methods for women with medical conditions or medially-relevant characteristics. For more detailed information, consult the above-named documents.
The tables below include recommendations on initiating use of common types of contraceptive methods:
- Combined oral contraceptive pills (COC)
- Progestogen only pills (POP)
- Progestogen only injectable (POI) e.g. DMPA
- Progestogen only implants (POIM)
- Copper-bearing IUD (CuIUD)
- LAM- Lactational amenorrhoea
Interpretation of eligibilty
Y- Use method
N- Do not use method
Drug Interactions
| DRUG | CONTRACEPTIVES | ||||
|---|---|---|---|---|---|
| COC | POP | POI | POIM | CUIUD | |
| Abacavir | Y | Y | Y | Y | Y |
| Tenofovir | Y | Y | Y | Y | Y |
| Zidovudine | Y | Y | Y | Y | Y |
| Lamivudine | Y | Y | Y | Y | Y |
| Efavirenz | Y | Y | Y | Y | Y |
| Nevirapine | Y | Y | Y | Y | Y |
| Atazanavir/r | Y | Y | Y | Y | Y |
| Lopinavir/r | Y | Y | Y | Y | Y |
| Darunavir/r | Y | Y | Y | Y | Y |
| Raltegravir | Y | Y | Y | Y | Y |
| Dolutegravir | Y | Y | Y | Y | Y |
| Phenytoin | N | N | Y | Y | Y |
| Phenobarbital | N | N | Y | Y | Y |
| Carbamazepine | N | N | Y | Y | Y |
| Broad spectrum antibiotic |
Y | Y | Y | Y | Y |
| Rifampicin | N | N | Y | Y | Y |
| Rifabutin | N | N | Y | Y | Y |
Medical Conditions and Patient Characteristics
| CONDITION | CONTRACEPTIVES | |||||
|---|---|---|---|---|---|---|
| COC | POP | POI | POIM | CUIUD | ||
| REPRODUCTIVE TRACT INFECTIONS AND DISORDERS | ||||||
| Unexplained vaginal bleeding | Y | Y | N | N | N | |
| Severe dysmenorrhoea |
Y | Y | Y | Y | Y | |
| Trophoblastic disease | Y | Y | Y | Y | N | |
| Uterine fibroids | Y | Y | Y | Y | Y | |
| Cervical neoplasia | Y | Y | Y | Y | Y | |
| Cervical cancer | Y | Y | Y | Y | N | |
| Current pelvic inflammatory disease |
Y | Y | Y | Y | Y | |
| Post abortion sepsis | Y | Y | Y | Y | N | |
| Breast cancer | N | N | N | N | Y | |
| LIVER DISEASES | ||||||
| Acute hepatitis | N | Y | Y | Y | Y | |
| Liver tumour | N | N | N | N | Y | |
| VENOUS THROMBOEMBOLISM (VTE E.G DVT, PE) | ||||||
| History of VTE | N | Y | Y | Y | Y | |
| Acute VTE | N | N | N | N | Y | |
| Major surgery with prolonged immobilisation |
N | N | Y | Y | Y | |
| CARDIOVASCULAR DISEASE | ||||||
| Ischaemic heart disease |
N | Y | N | Y | Y | |
| Stroke | N | Y | N | Y | Y | |
| Multiple risk factors e.g. dyslipidaemias |
Y | Y | Y | Y | Y | |
| HYPERTENSION, OBESITY AND DIABETES | ||||||
| BP 140-159/90-99 or adequately controlled |
N | Y | Y | Y | Y | |
| BP ≥160/99 mmHg | N | Y | N | Y | Y | |
| BMI ≥30 kg/m2 | – | – | – | – | – | |
| Diabetes (current) | Y | Y | Y | Y | Y | |
| Diabetes with neuro-, retinal or nephropathy |
N | Y | N | Y | Y | |
| Smoker Age ≥35 | N | Y | Y | Y | Y | |
| Smoker Age <35 | Y | Y | Y | Y | Y | |
| HEADACHE | ||||||
| Non-migraine headache |
Y | Y | Y | Y | Y | |
| Migraine with aura (neurological symptom) |
N | N | Y | Y | Y | |
| HIV AND STIS | ||||||
| HIV Clinical Stage 3 or 4 |
Y | Y | Y | Y | N | |
| Gonorrhoea | Y | Y | Y | Y | Y | |
| Chlamydia | Y | Y | Y | Y | Y | |
| Other STIs and vaginalis |
Y | Y | Y | Y | Y | |
| Increased risk of STIs | Y | Y | Y | Y | Y | |
| POSTPARTUM AND BREASTFEEDING | ||||||
| <48 hours | N | Y | N | Y | Y | |
| 48 hours to <4 weeks | N | Y | N | Y | N | |
| 4 weeks to <6 weeks | N | Y | N | Y | Y | |
| 6 weeks to <6 months (primary breastfeeding) |
N | Y | Y | Y | Y | |
| ≥6 months | Y | Y | Y | Y | Y | |
| Peurperal sepsis | Y | Y | Y | Y | N | |
| AGE AND PREGNANCY HISTORY (PARITY) | ||||||
| Adolescents (menarche to age < 18 years) |
Y | Y | Y | Y | Y | |
| Nulliparity | Y | Y | Y | Y | Y | |
| Parous | Y | Y | Y | Y | Y | |
| Pregnancy | NA | NA | NA | NA | NA | |
Notes on continuation
- If venous thromboembolism develops while on hormonal contraceptives, discontinue and choose another family planning method
Conditions where all methods can be used
| CATEGORY | CONDITIONS |
|---|---|
| Reproductive | Benign breast disease or undiagnosed mass, benign ovarian tumours and cysts, dysmenorrhoea, endometriosis, history of gestational diabetes, history of high blood pressure during pregnancy, history of pelvic surgery including caeserean delivery, irregular, heavy prolonged menstrual bleeding (explained), past ectopic pregnancy, past pelvic inflammatory disease, post-abortion (no sepsis), postpartum ≥6 months |
| Medical | Depression, epilepsy, HIV asymptomatic (WHO clinical stage 1 or 2), iron-deficiency anaemia, sickle-cell disease, thalassaemia, malaria, mild cirrhosis, schistosomiasis, superficial venous disorders including varicose veins, thyroid disorders, tuberculosis (non-pelvic), uncomplicated heart disease, viral hepatitis (carrier or chronic), cholecystitis, gall stones |
| Others | Adolescents, breast cancer family history, venous thromboembolism (VTE) family history, high risk for HIV, surgery without prolonged immobilisation, taking antibiotics (except rifampicin or rifabutin) |
Methods all couples (except a few) can safely use
- Emergency contraceptive pill (for emergency use only)
- Bilateral Tubal Ligation (BTL) and Vasectomy
- Barrier methods (condoms, diaphragm)
- Lactational amenorrhoea method (LAM)
- Fertility awareness (FAM) and Standard days methods