WHO Library Cataloguing-in-Publication Data

WHO
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.
MEDICAL ELIGIBILITY CRITERIA WHEEL
ISBN 978 92 4 154925 7 (NLM classification: WP 630) FOR CONTRACEPTIVE USE
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
2015
purchased from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland
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The designations employed and the presentation of the material in this publication do not imply the expression of any
C SEPSIS POSTPART
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opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or PID ND B
area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps REA
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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 WHOs 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 g 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 Non-nucleoside reverse
transcriptase inhibitors (NRTIs) 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 Rilpirivine RTV Ritonavir
DDI Didanosine
FTC Emtricitabine Integrase Inhibitors
D4T Stavudine RAL Raltegravir
Emergency contraceptive pills Copper IUD for Emergency Contraception (Cu-IUD)
CONDITION COC LNG UPA This method is highly effective for preventing pregnancy.
It can be used within 5 days of unprotected intercourse
Pregnancy NA NA NA
as an emergency contraceptive. However, when the
Breastfeeding 1 1 2 time of ovulation can be estimated, the Cu-IUD can be
Past ectopic pregnancy 1 1 1 inserted beyond 5 days after intercourse, if necessary,
Obesity (BMI 30 kg/m )
2
1 1 1 as long as the insertion does not occur more than 5 days
after ovulation.
History of severe 2 2 2
cardiovascular disease The eligibility criteria for general Cu-IUD insertion
(ischaemic heart disease, also apply for the insertion of Cu-IUDs as emergency
cerebrovascular attack, contraception.
or other thromboembolic
CONDITION Cu-IUD
conditions)
Migraine 2 2 2 Pregnancy 4
Severe liver disease 2 2 2 Rape
(including jaundice) a) High risk of STI 3
CYP3A4 inducers (e.g. 1 1 1 b) Low risk of STI 1
rifampicin, phenytoin,
phenobarbital,
carbamazepine, efavirenz,
fosphenytoin, nevirapine,
oxcarbazepine, primidone,
rifabutin, St Johns wort/
hypericum perforatum)
Repeated emergency 1 1 1
contraceptive pill use
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.
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:

WITH LIMITED
CATEGORY WITH CLINICAL JUDGEMENT
CLINICAL JUDGEMENT

1 Use method in any circumstance YES

(Use the method)
2 Generally use method
Use of method not usually
recommended unless other more
3 NO
appropriate methods are not
available or not acceptable (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.
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 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.
F If 3 to <6 wks, not breastfeeding & no other VTE risk factors =2, with other VTE risk factors =3.
G If 6 wks & not breastfeeding =1. R If <15 cigarettes/day CIC =2. If 15 cigarettes/day
H If uterine cavity distorted preventing insertion =4. COC/P/CVR =4.
I Refers to hepatocellular adenoma (benign) or carcinoma/ S Aura is focal neurological symptoms, such as flickering
hepatoma (malignant). 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.
J If adenoma CIC =3, if carcinoma/hepatoma CIC =3/4.
T Barbituates, carbamazepine, oxcarbazepine, phenytoin,
K CIC =3.
primidone, topiramate & lamotrigine.
L If established on anticoagulation therapy =2.
U If barbituates, carbamazepine, oxcarbazepine, phenytoin,
M If condition developed while on this method, consider primidone or topiramate CIC =2.
switching to non-hormonal method.
V If lamotrigine =1.
N Risk factors: older age, smoking, diabetes, hypertension,
W DMPA =1, NET-EN =2.
obesity & known dyslipidaemias.
X CICs =2.
O If cannot measure blood pressure & no known history
of hypertension, can use all methods. Either systolic or Y If antiretroviral therapy with EFV, NVP, ATV/r, LPV/r, DRV/r,
diastolic blood pressure may be elevated. RTV: COC/P/CVR, CIC, POP, NET-ET, Implants =2; DMPA =1.
For all NRTIs, ETR, RPV, RAL each method =1. See jacket
P If age <18 yrs & obese DMPA/NET-EN =2.
for full names of medications.
Q For insulin-dependent & non-insulin-dependent. If
Z If WHO Stage 3 or 4 (severe or advanced HIV clinical
complicated or >20 yrs duration, COC/P/CVR, CIC =3/4;
disease) IUD =3.
DMPA, NET-EN =3.

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
 tives Pill, pa
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1 Use the method in any 3 Use of the method not usually
circumstance recommended unless other, more
appropriate methods are not
available or acceptable
2 Generally use the method 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.
Acknowledgements
The Medical Eligibility Criteria for Contraceptive Use and this version of
the Medical Eligibility Criteria Wheel were developed by the Word Health
Organizations 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 Schools 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,
DrMary 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/