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Who mec for reproductive tract infections and disorders

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Who mec for reproductive tract infections and disorders

  1. 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. 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. 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. 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

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