This document provides an overview of the WHO Medical Eligibility Criteria for Contraceptive Use (WHO MEC, 2010). It discusses the objective to understand and use the tables and wheel in the WHO MEC to determine contraceptive method choice based on safety, effectiveness, availability, and acceptability. It then outlines the 4 categories for classifying methods based on current scientific evidence - from Category 1 being safe with no restrictions, to Category 4 being an unaccepted health risk. Specific examples are given for combined hormonal contraception (CHC) and conditions like breastfeeding, blood clots, weight/health issues, rheumatologic diseases, age, and smoking.

1. Understanding and using
WHO Medical Eligibility Criteria for
Contraceptive Use
(WHO MEC, 2010)
Prof. Aboubakr Elnashar
elnashar53@hotmail.com

2. Objective
Understanding and using
Tables
Wheel

3. Contraceptive Method Choice
1. Safety
2. Effectiveness
3. Availability (accessibility and affordability)
4. Acceptability.

4. Copper
IUD
Levonor
gestrel
IUD
ImplantInjectionPOPCombined
pill;
Patch
Ring

5.  Based on the current scientific evidence
 Category 1: Safe
No restriction for use
 Category 2: Usable
Advantages outweigh risks (theoretical or proven):
careful follow-up may be required
 Category 3: Not recommended
Risks(theoretical or proven) outweigh advantages
 Category 4: No use
Unaccepted health risk

6. I= Initiation of contraception
C= Continuation of contraception, NA= Not applicable

8. Breastfeeding: CHC
 < 1 month postpartum:
Category 3
 >1 month postpartum:
Category 2

11. DVT & PE: CHC
Acute DVT/PE: Category 4
DVT/PE on anticoagulant
for at least 3 months
 Higher risk of recurrence
Thrombophilia
Cancer
Recurrence
: Category 4
 Lower risk of recurrence
: Category 3

15. Bariatric Surgery: CHC
 Restrictive procedures:
(gastric band or sleeve):
Category 1
 Malabsorptive procedures
Malabsorption from method or SE of long term
vomiting/diarrhea
: COCs: Category 3
: P/Ring: Category 1

18. Hypertension: CHC
 Adequately controlled:
Category 3
 Elevated BP levels:
S 140-159 OR D 90-99
: Category 3
S > 160 OR D > 100
: Category 4
 Vascular disease: Category 4
 Hypertension during
pregnancy: Category 2

20. Obesity: CHC
 BMI > 30: Category 2
{Possible increased risk
of VTE, MI, stroke}

24. Rheumatic Diseases: CHC
 SLE
 Positive or unknown
APL antibodies: C4
 Thrombocytopenia: C2
 Immunosuppression: C2
 None of above: C2
 Rheumatoid Arthritis
 Immunosuppression:
C2
 Non-suppressed: C2

25. Age: CHC
Menarche to <40 years:
Category 1
> 40 years old: Category 2
Smoking: CHC
<35 and smoke: 2
>35 and smoke <15/day: 3
>35 and smoke > 15/day: 4

31. Thank you
Aboubakr Elnashar