U.S. Selected Practice Recommendations for Contraceptive Use, 2016

Abstract

The 2016 U.S. Selected Practice Recommendations for Contraceptive Use (U.S. SPR) addresses a select group of common, yet sometimes controversial or complex, issues regarding initiation and use of specific contraceptive methods. These recommendations for health care providers were updated by CDC after review of the scientific evidence and consultation with national experts who met in Atlanta, Georgia, during August 26-28, 2015. The information in this report updates the 2013 U.S. SPR (CDC. U.S. selected practice recommendations for contraceptive use, 2013. MMWR 2013;62[No. RR-5]). Major updates include 1) revised recommendations for starting regular contraception after the use of emergency contraceptive pills and 2) new recommendations for the use of medications to ease insertion of intrauterine devices. The recommendations in this report are intended to serve as a source of clinical guidance for health care providers and provide evidence-based guidance to reduce medical barriers to contraception access and use. Health care providers should always consider the individual clinical circumstances of each person seeking family planning services. This report is not intended to be a substitute for professional medical advice for individual patients. Persons should seek advice from their health care providers when considering family planning options.

Long-acting reversible contraception in adolescents: a systematic review and meta-analysis

“…9 In the Selected Practice Recommendations for Contraceptive Use, the Centers for Disease Control and Prevention (CDC) acknowledge that LARCs are the most effective reversible methods and are appropriate for adolescents and nulliparous women. [10][11][12] Although multiple studies discuss continuation of LARC methods in the adolescent population, there is no consensus of continuation rates for IUDs and implants among adolescents and young women. The objective of this systematic review is to provide an assessment of the findings of the medical literature of the use of LARC methods in young women age <25 years.…”

Long-Acting Reversible Contraception

“…18 If a woman with risk factors for STDs has not been screened according to the guidelines, screening can be performed at the time of insertion of the IUD, and insertion should not be delayed (Table 2). 19 Women who have cervical or endometrial cancers should not undergo IUD insertion but may continue to use an IUD while awaiting cancer treatment. 17 Given theoretical concerns about the adverse effects of progestin on breast cancer, the use of the LNG-IUD is considered to be contraindicated in women with current breast cancer and is generally not recommended in women who had recent breast cancer; however, evidence to assess this concern is limited.…”

Unintended pregnancy: a framework for prevention and options for midlife women in the US

“…Contraceptive methods should be individualized based on the women's health history: for example, contraceptives containing estrogen may not be ideal for women with hypertension, diabetes, cancer or other chronic medical conditions. Newer combined oral contraceptive (COC) preparations contain low dose estrogen and progestogen and are safe, and monophasic pill with 30 mcg or less of estrogen are considered an appropriate first line choice, safe and effective for women with chronic medical conditions [10,11,18]. (see Table 2).…”

“…It is critically important to note that not all midlife women are eligible to use all forms of EC. Healthcare providers should refer to the U.S. Medical Eligibility Criteria for Contraceptive Use, 2016 [18] for guidance as to whether women with particular medical conditions or lifestyle behaviors can use specific EC methods.…”