[Table, Progesterone-releasing vaginal ring (PVR) for breastfeeding women]. - Medical Eligibility Criteria for Contraceptive Use

PROGESTERONE-RELEASING VAGINAL RING FOR BREASTFEEDING WOMEN
PREGNANCY	NA	NA = not applicable Clarification: Use of PVRs is not required. There is no known harm to the woman, the course of her pregnancy, or the fetus if PVRs are accidentally used during pregnancy.
BREASTFEEDING ≥ 4 WEEKS POSTPARTUM †	1	Clarification: The woman must be actively breastfeeding (i.e. at least 4 breastfeeding episodes per day) during PVR use to maintain efficacy. Evidence: No differences were observed between various measures of breastfeeding performance among PVR users compared with users of non-hormonal or progestogen-only (synthetic progesterone) contraceptives during 12 months of observation (3–8). No statistically significant differences in infant weight gain were observed among PVR users compared with women using a non-hormonal or progestogen-only contraceptives (5, 7, 9), and similar patterns of infant weight gain were observed in another study that compared PVR and IUD users (8). One study reported no significant difference in infant health (8).

PROGESTERONE-RELEASING VAGINAL RING FOR BREASTFEEDING WOMEN

PVRs do not protect against sexually transmitted infections (STIs), including HIV. If there is a risk of STI/HIV, the correct and consistent use of condoms is recommended. When used correctly and consistently, condoms offer one of the most effective methods of protection against STIs, including HIV. Female condoms are effective and safe, but are not used as widely by national programmes as male condoms.

CONDITION
^† recommendations reviewed for the MEC 5th edition, further details after this table

CATEGORY

CLARIFICATIONS/EVIDENCE

PREGNANCY

NA = not applicable

Clarification: Use of PVRs is not required. There is no known harm to the woman, the course of her pregnancy, or the fetus if PVRs are accidentally used during pregnancy.

BREASTFEEDING ≥ 4 WEEKS POSTPARTUM †

Clarification: The woman must be actively breastfeeding (i.e. at least 4 breastfeeding episodes per day) during PVR use to maintain efficacy.

Evidence: No differences were observed between various measures of breastfeeding performance among PVR users compared with users of non-hormonal or progestogen-only (synthetic progesterone) contraceptives during 12 months of observation (3–8). No statistically significant differences in infant weight gain were observed among PVR users compared with women using a non-hormonal or progestogen-only contraceptives (5, 7, 9), and similar patterns of infant weight gain were observed in another study that compared PVR and IUD users (8). One study reported no significant difference in infant health (8).

From: II, Using the recommendations

Cover of Medical Eligibility Criteria for Contraceptive Use

Medical Eligibility Criteria for Contraceptive Use. 5th edition.

Geneva: World Health Organization; 2015.

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