This document is the 2015 update of the WHO Medical Eligibility Criteria Wheel for Contraceptive Use. It provides guidance for health providers on recommending safe and effective contraception methods for women with various medical conditions. The wheel matches 9 common contraceptive methods (such as pills, IUDs, implants) with medical factors (such as STIs, migraines, liver disease) using a 1-4 categorization system, with 1 indicating the method can generally be used and 4 indicating it should not be used. It aims to help providers determine eligibility and make informed choices about contraception.

1. MEDICAL ELIGIBILITY CRITERIA WHEEL
FOR CONTRACEPTIVE USE
WHO
2015
c
o
n
v
u
l
s
a
n
t
s
T
<
1
8
y
e
a
r
s
abortion
STIs
vaginitis
S
t
a
g
e
3
o
r
4
t
h
e
r
a
p
y
R
i
f
a
b
u
t
i
n
a
n
t
i
-
t
o
a
g
e
<6 months
<6 weeks
<4 weeks
and post-
risk of
and
C
h
l
a
m
ydia
A
n
t
i
r
e
t
r
o
v
i
r
a
l
R
i
f
a
m
p
i
c
i
n
/
C
e
r
t
a
i
n
U
n
e
x
p
l
a
i
n
e
d
M
e
n
a
r
c
h
e
6 weeks to
4 weeks to
48 hours to
<48 hours
Puerperal
Current
Increased
Other STIs
G
o
n
o
r
rhoea
W
H
O
2
4
A
3
A
2
/
3
Z
,A
1
1
1
1
H
4
A
2
2
1
1
3
1
4
4A
2/3
B
2
4
A
3
A
2
/
3
Z
,A
1
1
2
1
H
4
A
2
2
1
1
3
2E
4
4A
2/3
B
1
1
1
-
2
Y
2
2
V
2
1
3
1
1
1
2
2
2
1
1
1
1
1
1
1
-
2
Y
1
-
2
W
1-
2
W,V
2
1
3
2
1
1
3
3
3
1
1
1
1
1
1
1
-
2
Y
3
3
V
1
1
2
1
1
1
2
2
2
1
1
1
1
1
1
1
-
2
Y
3
X
3
U
2
1
2
1
1
3 G
4 F
4D,F
4D
1
1
1
1
N
E
O
P
L
A
S
I
A
F
I
B
R
O
I
D
S
B
L
E
E
D
I
N
G
INFECTIONS
INFECTIONS
INFECTIONS
S
EXUALLY TRANSMITTED
M
E
D
I
C
A
T
I
O
N
S
C
E
R
V
I
C
A
L
U
T
E
R
I
N
E
V
A
G
I
N
A
L
A
D
O
L
E
S
C
E
N
T
S
NULLI
P
A
R
I
T
Y
POSTPARTUM AND BREASTFEEDING
SEPSIS
P I DC
H
I
V
Progestogen-only pills 2 POP
P
r
o
g
e
stin-only injectables 3 DMPA (IM, SC) /
N
E
T
-
E
N
L
e
v
o
n
orgestrel IUD 2E
LNG-IUD
C
o
pper IUD 1 Cu-IUD
Implants 2 LNG /ETG
C
o
m
b
i
n
e
d
hormonal contraceptives 4D
Pill, patch, ring, injec
t
a
b
l
e
(
C
O
C
,
P
,
C
V
R
,
C
I
C
)
ISBN 978 92 4 154925 7
WHO Library Cataloguing-in-Publication Data
WHO medical eligibility criteria wheel for contraceptive use – 2015 update.
1.Contraception - methods. 2.Family Planning Services - methods. 3.Eligibility Determination - standards.
I.World Health Organization.
ISBN 978 92 4 154925 7 (NLM classification: WP 630)
© World Health Organization 2015
All rights reserved. Publications of the World Health Organization are available on the WHO website (www.who.int) or can be
purchased from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland
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Requests for permission to reproduce or translate WHO publications –whether for sale or for non-commercial distribution–
should be addressed to WHO Press through the WHO website (www.who.int/about/licensing/copyright_form/en/index.html).
The designations employed and the presentation of the material in this publication do not imply the expression of any
opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or
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The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health
Organization be liable for damages arising from its use.
Printed in France

2. About this wheel
This wheel contains the medical eligibility criteria for starting use of contraceptive methods, based on Medical Eligibility
Criteria for Contraceptive Use, 5th
edition (2015), one of WHO’s evidence-based guidelines. It guides family planning providers
in recommending safe and effective contraception methods for women with medical conditions or medically-relevant
characteristics.
The wheel includes recommendations on initiating use of nine common types of contraceptive methods:
1. Combined pills, COC (low dose combined oral contraceptives, with ≤ 35 μg ethinyl estradiol)
2. Combined contraceptive patch, P
3. Combined contraceptive vaginal ring, CVR
4. Combined injectable contraceptives, CIC
5. Progestogen-only pills, POP
6. Progestogen-only injectables, DMPA (IM,SC)/NET-EN (depot medroxyprogesterone acetate intramuscular or subcutaneous
or norethisterone enantate intramuscular)
7. Progestogen-only implants, LNG/ETG (levonorgestrel or etonogestrel)
8. Levonorgestrel-releasing intrauterine device, LNG-IUD
9. Copper-bearing intrauterine device, Cu-IUD
Antiretroviral Medications and Abbreviations on the MEC Wheel
Nucleoside reverse
transcriptase inhibitors (NRTIs)
Non-nucleoside reverse
transcriptase inhibitors (NNRTIs) Protease inhibitors (PIs)
ABC Abacavir EFV Efavirenz ATV/r Ritonavir-boosted atazanavir
TDF Tenofovir ETR Etravirine LPV/r Ritonavir-boosted lopinavir
AZT Zidovudine NVP Nevirapine DRV/r Ritonavir-boosted darunavir
3TC Lamivudine RPV Ripirivine RTV Ritonavir
DDI Didanosine
FTC Emtricitabine Integrase Inhibitors
D4T Stavudine RAL Raltegravir

3. Emergency contraceptive pills
CONDITION COC LNG UPA
Pregnancy NA NA NA
Breastfeeding 1 1 2
Past ectopic pregnancy 1 1 1
Obesity†
(BMI ≥30 kg/m2
) 1 1 1
History of severe
cardiovascular disease
(ischaemic heart disease,
cerebrovascular attack,
or other thromboembolic
conditions)
2 2 2
Migraine 2 2 2
Severe liver disease
(including jaundice)
2 2 2
CYP3A4 inducers (e.g.
rifampicin, phenytoin,
phenobarbital,
carbamazepine, efavirenz,
fosphenytoin, nevirapine,
oxcarbazepine, primidone,
rifabutin, St John’s wort/
hypericum perforatum)
1 1 1
Repeated emergency
contraceptive pill use
1 1 1
Rape 1 1 1
COC = combined oral contraceptives; LNG = levonorgestrel;
UPA = ulipristal acetate; NA = not applicable
†
Emergency contraceptive pills may be less effective among women
with BMI ≥ 30 kg/m2
than among women with BMI < 25 kg/m2
.
Despite this, there are no safety concerns.
Copper IUD for Emergency Contraception (Cu-IUD)
This method is highly effective for preventing pregnancy.
It can be used within 5 days of unprotected intercourse
as an emergency contraceptive. However, when the
time of ovulation can be estimated, the Cu-IUD can be
inserted beyond 5 days after intercourse, if necessary,
as long as the insertion does not occur more than 5 days
after ovulation.
The eligibility criteria for general Cu-IUD insertion
also apply for the insertion of Cu-IUDs as emergency
contraception.
CONDITION Cu-IUD
Pregnancy 4
Rape
a) High risk of STI 3
b) Low risk of STI 1

4. How to use this wheel
The wheel matches up the contraceptive methods, shown on the inner
disk, with specific medical conditions or characteristics shown around
the outer rim. The numbers shown in the viewing slot tell you whether
the woman who has this known condition or characteristic is able to
start use of the contraceptive method:
CATEGORY WITH CLINICAL JUDGEMENT
WITH LIMITED
CLINICAL JUDGEMENT
1 Use method in any circumstance YES
(Use the method)
2 Generally use method
3
Use of method not usually
recommended unless other more
appropriate methods are not
available or not acceptable
NO
(Do not use the
method)
4 Method not to be used
Categories 1 and 4 are clearly defined recommendations. For categories
2 or 3, greater clinical judgement will be needed and careful follow-up
may be required. If clinical judgement is limited, categories 1 and 2 both
mean the method can be used, and categories 3 and 4 both mean the
method should not be used.
No restrictions for some conditions: there are many medical conditions
when ALL methods can be used (that is, all the methods are either a
category 1 or 2). Some of these conditions are listed on the back of the
wheel.
With few exceptions, all women can safely use emergency
contraception, barrier and behavioral methods of contraception,
including lactational amenorrhea method; for the complete list of
recommendations, please see the full document.
Only correct and consistent use of condoms, male or female,
protect against STI/HIV. If there is a risk of STI/HIV, condom use is
recommended.

5. c
o
n
v
u
l
s
a
n
t
s
T
c
o
n
t
r
o
ll
e
d
f
a
c
t
o
r
s
N
d
i
s
e
a
s
e
i
m
m
o
b
i
l
i
z
a
i
o
n
<
1
8
y
e
a
r
s
abortion
STIs
vaginitis
S
t
a
g
e
3
o
r
4
t
h
e
r
a
p
y
R
i
f
a
b
u
t
i
n
a
n
t
i
-
w
i
t
h
a
u
r
a
S
m
i
g
r
a
n
o
u
s
>
3
0
k
g
/
m
2
o
r
a
d
e
q
u
a
t
e
l
y
r
i
s
k h
e
a
r
t
w
i
t
h
p
r
o
l
o
n
g
e
d
a
c
u
t
e
/
fl
a
r
e
t
u
m
o
u
r
I
t
r
e
a
t
m
e
n
t
t
o
a
g
e
<6 months
<6 weeks
<4 weeks
and post-
risk of
and
C
h
l
a
m
ydia
A
n
t
i
r
e
t
r
o
v
i
r
a
l
R
i
f
a
m
p
i
c
i
n
/
C
e
r
t
a
i
n
M
i
g
r
a
i
n
e
N
o
n
-
A
g
e
>
3
5
A
g
e
<
3
5
C
u
r
r
e
n
t
B
M
I
>
1
6
0
/
>
1
0
0
1
4
0
-
1
5
9
/9
0
-
9
9
M
u
l
t
i
p
l
e I
s
c
h
a
e
m
i
c
S
t
r
o
k
e
M
a
j
o
r
s
u
r
g
e
r
y
A
c
u
t
e
H
i
s
t
o
r
y
H
e
p
a
t
i
t
i
s
L
i
v
e
r
C
u
r
r
e
n
t
P
r
e
-
U
n
e
x
p
l
a
i
n
e
d
M
e
n
a
r
c
h
e
6 weeks to
4 weeks to
48 hours to
<48 hours
Puerperal
Current
Increased
Other STIs
G
o
n
o
rrhoea
W
H
O
2
4
A
3
A
2
/
3
Z
,A
1
1
1
1
1
1
1
1
1 1 1 1 1 1
1
1
1
1
1
4
A
1
1
H
4
A
2
2
1
1
3
1
4
4A
2/3
B
2
4
A
3
A
2
/
3
Z
,A
1
1
2
M
1
1
1
2
1
2 1 2 2
M
2
2
3
L
2
1
3
4
4
A
2
1
H
4
A
2
2
1
1
3
2E
4
4A
2/3
B
1
1
1
-
2
Y
2
2
V
2
M
1
1
1
2
1
2
1 2 2
M
2
M
2
3
L
2
1
3
4
2
2
1
3
1
1
1
2
2
2
1
1
1
1
1
1
1
-
2
Y
1
-
2
W
1-
2
W,V
2
M
1
1
1
2
Q
1
P
3
2 3 3 3
2
3
L
2
1
3
4
2
2
1
3
2
1
1
3
3
3
1
1
1
1
1
1
1
-
2
Y
3
3
V
2
M,S
1
1
1
2
1
2
1 2 2
M
2
M
2
3
L
2
1
3
4
1
1
1
2
1
1
1
2
2
2
1
1
1
1
1
1
1
-
2
Y
3
X
3
U
4
S
1
3
R
2
2
Q
2
4
3
3/
4 4
4
4
4
4
3
/
4
K
,
A
4
J
4
2
2
1
2
1
1
3 G
4 F
4D,F
4D
1
1
1
1
D
I
S
E
A
S
E
C
A
N
C
E
R
C
A
N
C
E
R
N
E
O
P
L
A
S
I
A
F
I
B
R
O
I
D
S
B
L
E
E
D
I
N
G
INFECTIONS
INFECTIONS
INFECTIONS
S
EXUALLY TRANSMITTED
M
E
D
I
C
A
T
I
O
N
S
H
E
A
D
A
C
H
E
S
M
O
K
I
N
G
D
I
A
B
E
T
E
S
Q
O
B
E
S
I
T
Y
H
Y
P
E
R
T
E
N
S
I
O
N
O
C
A
R
D
I
O
V
A
S
C
U
L
A
R
V
E
N
O
U
S
T
H
R
O
M
B
O
E
M
B
O
L
I
S
M L
I
V
E
R
D
I
S
E
A
S
E
S
B
R
E
A
S
T
C
E
R
V
I
C
A
L
C
E
R
V
I
C
A
L
U
T
E
R
I
N
E
V
A
G
I
N
A
L
A
D
O
L
E
S
C
E
N
T
S
NULLI
P
A
R
I
T
Y
POSTPARTUM AND BREASTFEEDING
SEPSIS
P I DC
H
I
V

6. Conditions that are category 1 and 2 for all methods (method can be used)
Reproductive Conditions: Benign breast disease or undiagnosed mass • Benign ovarian tumours, including cysts • Dysmenorrhoea • Endometriosis • History
of gestational diabetes • History of high blood pressure during pregnancy • History of pelvic surgery, including caesarean delivery • Irregular, heavy or
prolonged menstrual bleeding (explained) • Past ectopic pregnancy • Past pelvic inflammatory disease • Post-abortion (no sepsis) • Postpartum ≥ 6 months
Medical Conditions: Depression • Epilepsy • HIV asymptomatic or mild clinical disease (WHO Stage 1 or 2) • Iron-deficiency anaemia, sickle-cell disease
and thalassaemia • Malaria • Mild cirrhosis • Schistosomiasis (bilharzia) • Superficial venous disorders, including varicose veins • Thyroid disorders
• Tuberculosis (non-pelvic) • Uncomplicated valvular heart disease • Viral hepatitis (carrier or chronic)
Other: Adolescents • Breast cancer family history • Venous thromboembolism (VTE) family history • High risk for HIV
• Surgery without prolonged immobilization • Taking antibiotics (excluding rifampicin/rifabutin)
With few exceptions, all women can safely use emergency contraception, barrier and behavioural methods of contraception, including
lactational amenorrhoea method; for the complete list of recommendations, please see the full document.
“Combined” is a combination of ethinyl estradiol & a progestogen.
CIC: combined injectable contraceptive COC: combined oral contraceptive pill
Cu-IUD: copper intrauterine device CVR: combined contraceptive vaginal ring
DMPA (IM, SC): depot medroxyprogesterone acetate, intramuscular or subcutaneous
ETG: etonogestrel LNG: levonorgestrel LNG-IUD: levonorgestrel intrauterine device
NET-EN: norethisterone enanthate P: combined contraceptive patch
POP: progestogen-only pill
A If condition develops while using method, can continue using it during treatment.
B If very high likelihood of exposure to gonorrhoea or chlamydia =3.
C If past pelvic inflammatory disease (PID) all methods =1, including IUDs.
D If <3 wks, not breastfeeding & no other VTE risk factors =3.
E If not breastfeeding =1.
R If <15 cigarettes/day CIC =2. If ≥15 cigarettes/day
COC/P/CVR =4.
S Aura is focal neurological symptoms, such as flickering
lights. If no aura & age <35 COC/P/CVR, CIC =2, POP =1.
If no aura & age ≥35 COC/P/CVR, CIC =3, POP =1.
T Barbituates, carbamazepine, oxcarbazepine, phenytoin,
primidone, topiramate & lamotrigine.
U If barbituates, carbamazepine, oxcarbazepine, phenytoin,
primidone or topiramate CIC =2.
V If lamotrigine =1.
W DMPA =1, NET-EN =2.
X CICs =2.
Y If antiretroviral therapy with EFV, NVP, ATV/r, LPV/r, DRV/r,
RTV: COC/P/CVR, CIC, POP, NET-ET, Implants =2; DMPA =1.
For all NRTIs, ETR, RPV, RAL each method =1. See jacket
for full names of medications.
Z If WHO Stage 3 or 4 (severe or advanced HIV clinical
disease) IUD =3.
G If ≥6 wks & not breastfeeding =1.
H If uterine cavity distorted preventing insertion =4.
I Refers to hepatocellular adenoma (benign) or carcinoma/
hepatoma (malignant).
J If adenoma CIC =3, if carcinoma/hepatoma CIC =3/4.
K CIC =3.
L If established on anticoagulation therapy =2.
M If condition developed while on this method, consider
switching to non-hormonal method.
N Risk factors: older age, smoking, diabetes, hypertension,
obesity & known dyslipidaemias.
O If cannot measure blood pressure & no known history
of hypertension, can use all methods. Either systolic or
diastolic blood pressure may be elevated.
P If age <18 yrs & obese DMPA/NET-EN =2.
Q For insulin-dependent & non-insulin-dependent. If
complicated or >20 yrs duration, COC/P/CVR, CIC =3/4;
DMPA, NET-EN =3.
F If 3 to <6 wks, not breastfeeding & no other VTE risk factors =2, with other VTE risk factors =3.

7. Use the method in any
circumstance
Use of the method not usually
recommended unless other, more
appropriate methods are not
available or acceptable
1
Generally use the method
2
3
4 Method NOT to be used
WHO Medical Eligibility Criteria Wheel
for contraceptive use, 2015
These methods do not protect against STI/HIV. If there is a risk of STI/HIV, the
correct and consistent use of condoms, male or female, is recommended.
C
o
m
b
i
n
e
d
h
ormonal contraceptives Pill, patch, ring, injectab
l
e
(
C
O
C
,
P
,
C
V
R
,
C
I
C
)
P
r
ogestogen-only pills POP
P
r
o
g
e
s
t
o
g
e
n-only injectables DMPA (IM, SC) / N
E
T
-
E
N
L
e
v
o
n
o
r
gestrel IUD LNG-IUD
C
o
p
per IUD Cu-IUD
Implants LNG /ETG

8. Acknowledgements
The Medical Eligibility Criteria for Contraceptive Use and this version of
the Medical Eligibility Criteria Wheel were developed by the Word Health
Organization’s Department of Reproductive Health and Research. This
wheel is based upon similar medical eligibility criteria wheels developed
independently in Ghana and Jordan. In particular, we would like to thank
the University of Ghana Medical School’s Department of Obstetrics
and Gynaecology; the Communication Partnership for Family Health
in Jordan; and the Johns Hopkins Bloomberg School of Public Health/
Center for Communications Programs for their innovative work.
Dr Anna Altshuler was responsible for this 2015 edition, in collaboration
with Dr Erin Berry-Bibee, Dr Kathryn Curtis, Dr Monica Dragoman,
Dr Mary Lyn Gaffield, Dr Tara Jatlaoui, and Ms Halley Riley.
Layout and design: Ms Cath Hamill
Ordering copies and further information
Detailed information on the medical eligibility criteria, including
guidance on other contraceptive methods, appears in the Medical
Eligibility Criteria for Contraceptive Use, 5th edition (2015). This can be
accessed at http://www.who.int/reproductivehealth/en/. Bulk orders
(20 wheels/package) to supply programmes or single orders can be
ordered from: WHO Press, World Health Organization, 1211 Geneva 27,
Switzerland, email: bookorders@who.int. Order online: http://apps.who.
int/bookorders/