This document summarizes guidelines from the World Health Organization (WHO) on the use of various contraceptive methods for individuals with different reproductive tract infections and disorders. It provides ratings from 1-4 (1 being no restriction and 4 being unacceptable health risk) for the use of various contraceptive options like combined oral contraceptives, implants, IUDs, and others depending on medical conditions like irregular bleeding, STIs, cancer history, and others. Conditions are listed along with their corresponding ratings for multiple contraceptive methods.

1. 7/20/2014 WHO MEC for reproductive tract infections and disorders
http://www.uptodate.com.myaccess.library.utoronto.ca/contents/image?imageKey=OBGYN%2F60832&rank=1~150&search=contracep%C3%A7%C3%A3o&source=image_view&view=print&topicKey=OBGYN/5459&source=se… 1/4
Official reprint from UpToDate®
www.uptodate.com ©2014 UpToDate®
World Health Organization medical eligibility for contraceptive use: Reproductive tract infections and
disorders
Condition COC CIC P/R POP
DMPA
NET­
EN
LNG/ETG
Implants
Cu­IUD LNG­IUD
Vaginal bleeding patterns
Irregular pattern without heavy bleeding 1 1 1 2 2 2 1 Initiation: 1
Continuation:
1
Heavy or prolonged bleeding (includes regular and irregular
patterns)
1 1 1 2 2 2 2 Initiation: 1
Continuation:
2
Unexplained vaginal bleeding (suspicious for serious condition)
Before evaluation 2 2 2 2 3 3 Initiation: 4 Initiation: 4
Continuation:
2
Continuation:
2
Endometriosis 1 1 1 1 1 1 2 1
Benign ovarian tumors (including cysts) 1 1 1 1 1 1 1 1
Severe dysmenorrhoea 1 1 1 1 1 1 2 1
Gestational trophoblastic disease
Decreasing or undetectable human chorionic gonadotropin
levels
1 1 1 1 1 1 3 3

2. 7/20/2014 WHO MEC for reproductive tract infections and disorders
http://www.uptodate.com.myaccess.library.utoronto.ca/contents/image?imageKey=OBGYN%2F60832&rank=1~150&search=contracep%C3%A7%C3%A3o&source=image_view&view=print&topicKey=OBGYN/5459&source=se… 2/4
Persistently elevated human chorionic gonadotropin levels
or malignant disease
1 1 1 1 1 1 4 4
Cervical ectropion 1 1 1 1 1 1 1 1
Cervical intraepithelial neoplasia (CIN) 2 2 2 1 2 2 1 2
Cervical cancer (awaiting treatment) 2 2 2 1 2 2 Initiation: 4 Initiation: 4
Continuation:
2
Continuation:
2
Breast disease
Undiagnosed mass 2 2 2 2 2 2 1 2
Benign breast disease 1 1 1 1 1 1 1 1
Family history of cancer 1 1 1 1 1 1 1 1
Cancer
Current 4 4 4 4 4 4 1 4
Past and no evidence of current disease for five years 3 3 3 3 3 3 1 3
Endometrial cancer 1 1 1 1 1 1 Initiation: 4 Initiation: 4
Continuation:
2
Continuation:
2
Ovarian cancer 1 1 1 1 1 1 Initiation: 3 Initiation: 3
Continuation:
2
Continuation:
2
Uterine fibroids
Without distortion of the uterine cavity 1 1 1 1 1 1 1 1
With distortion of the uterine cavity 1 1 1 1 1 1 4 4
Anatomical abnormalities
That distort the uterine cavity 4 4
That do not distort the uterine cavity 2 2
Pelvic inflammatory disease (PID)

3. 7/20/2014 WHO MEC for reproductive tract infections and disorders
http://www.uptodate.com.myaccess.library.utoronto.ca/contents/image?imageKey=OBGYN%2F60832&rank=1~150&search=contracep%C3%A7%C3%A3o&source=image_view&view=print&topicKey=OBGYN/5459&source=se… 3/4
Past PID (assuming no current risk factors of STIs)
With subsequent pregnancy 1 1 1 1 1 1 Initiation: 1 Initiation: 1
Continuation:
1
Continuation:
1
Without subsequent pregnancy 1 1 1 1 1 1 Initiation: 2 Initiation: 2
Continuation:
2
Continuation:
2
PID ­ current or within last three months 1 1 1 1 1 1 Initiation: 4 Initiation: 4
Continuation:
2
Continuation:
2
STIs (sexually transmitted infections)
Current purulent cervicitis or chlamydial infection or
gonorrhoea
1 1 1 1 1 1 Initiation: 4 Initiation: 4
Continuation:
2
Continuation:
2
Other STIs (excluding HIV and hepatitis) 1 1 1 1 1 1 Initiation: 2 Initiation: 2
Continuation:
2
Continuation:
2
Vaginitis (including trichomonas vaginalis and bacterial
vaginosis)
1 1 1 1 1 1 Initiation: 2 Initiation: 2
Continuation:
2
Continuation:
2
Increased risk of STIs 1 1 1 1 1 1 Initiation:
2/3
Initiation:
2/3
Continuation:
2
Continuation:
2
1: A condition for which there is no restriction for the use of the contraceptive method.
2: A condition where the advantages of using the method generally outweigh the theoretical or proven risks.
3: A condition where the theoretical or proven risks usually outweigh the advantages of using the method.
4: A condition which represents an unacceptable health risk if the contraceptive method is used.
COC: low­dose combined oral contraceptive; CIC: combined injectable contraceptives; P: combined patch; R: combined vaginal ring; POP: progestogen­only pill;

4. 7/20/2014 WHO MEC for reproductive tract infections and disorders
http://www.uptodate.com.myaccess.library.utoronto.ca/contents/image?imageKey=OBGYN%2F60832&rank=1~150&search=contracep%C3%A7%C3%A3o&source=image_view&view=print&topicKey=OBGYN/5459&source=se… 4/4
DMPA: depot medroxyprogesterone acetate; NET­EN: norethisterone enantate; LNG: levonorgestrel; ETG: etonogestrel; ECP: emergency contraceptive pill;
Cu­IUD: copper intrauterine device; LNG­IUD: levonorgestrel­releasing IUDs; E­IUD: copper­IUD for emergency contraception; BARR: barrier methods; FAB:
fertility awareness­based methods; LAM: lactational amenorrhoea method; CI: coitus interruptus; STER: female and male sterilization.
Reproduced with permission from: http://www.who.int/reproductive­health/publications/mec/summary.html. Copyright © 2006 World Health Organization.
Updated and revised 2009.
Graphic 60832 Version 5.0