Summary of Medical Eligibilty for Contraceptives

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:

  1. Combined oral contraceptive pills (COC)
  2. Progestogen only pills (POP)
  3. Progestogen only injectable (POI) e.g. DMPA
  4. Progestogen only implants (POIM)
  5. Copper-bearing IUD (CuIUD)
  6. 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

  1. Emergency contraceptive pill (for emergency use only)
  2. Bilateral Tubal Ligation (BTL) and Vasectomy
  3. Barrier methods (condoms, diaphragm)
  4. Lactational amenorrhoea method (LAM)
  5. Fertility awareness (FAM) and Standard days methods