Table 2.4, Summary of changes from the fourth edition to the fifth edition of the MEC (changes are highlighted in bold) - Medical Eligibility Criteria for Contraceptive Use

Condition	COC/P/CVR	CIC	POP	DMPA NET-EN	LNG/ETG implants	Cu-IUD	LNG-IUD
Breastfeeding
a) < 6 weeks postpartum	4	4	2^a	3^a	2^a
b) ≥ 6 weeks to < 6 months (primarily breastfeeding)	3	3	1	1	1
c) ≥ 6 months postpartum	2	2	1	1	1

Postpartum (non-breastfeeding women)
a) < 21 days			1	1	1
(i) without other risk factors for VTE	3^a	3^a
(ii) with other risk factors for VTE	4^a	4^a
b) ≥ 21 days to 42 days			1	1	1
(i) without other risk factors for VTE	2^a	2^a
(ii) with other risk factors for VTE	3^a	3^a
c) ≥ 42 days	1	1	1	1	1

Postpartum (breastfeeding or non-breastfeeding women, including after caesarean section)
a) < 48 hours including insertion immediately after delivery of the placenta						1	not BF=1; BF=2
b) ≥ 48 hours to < 4 weeks						3	3
c) ≥ 4 weeks						1	1
d) Puerperal sepsis						4	4

Superficial venous disorders
a) Varicose veins	1	1	1	1	1	1	1
b) Superficial venous thrombosis	2^a	2^a	1	1	1	1	1

Known dyslipidaemias without other known cardiovascular risk factors	2^a	2^a	2^a	2^a	2^a	1^a	2^a

STIs						I	C	I	C

a) Current purulent cervicitis or chlamydial infection or gonorrhoea	1	1	1	1	1	4	2^a	4	2^a
b) Other STIs (excluding HIV and hepatitis)	1	1	1	1	1	2	2	2	2
c) Vaginitis (including Trichomonas vaginalis and bacterial vaginosis)	1	1	1	1	1	2	2	2	2
d) Increased risk of STIs	1	1	1	1	1	2/3^a	2	2/3^a	2

HIV/AIDS						I	C	I	C

High risk of HIV	1	1	1	1^a	1	2	2	2	2
Asymptomatic or mild HIV clinical disease (WHO stage 1 or 2)	1^a	1^a	1^a	1^a	1^a	2	2	2	2
Severe or advanced HIV clinical disease (WHO stage 3 or 4)	1^a	1^a	1^a	1^a	1^a	3	2^a	3	2^a

Antiretroviral therapy
a) Nucleoside reverse transcriptase inhibitors (NRTIs)						I	C	I	C

Abacavir (ABC)	1	1	1	1	1	2/3^a	2^a	2/3^a	2^a
Tenofovir (TDF)	1	1	1	1	1	2/3^a	2^a	2/3^a	2^a
Zidovudine (AZT)	1	1	1	1	1	2/3^a	2^a	2/3^a	2^a
Lamivudine (3TC)	1	1	1	1	1	2/3^a	2^a	2/3^a	2^a
Didanosine (DDI)	1	1	1	1	1	2/3^a	2^a	2/3^a	2^a
Emtricitabine (FTC)	1	1	1	1	1	2/3^a	2^a	2/3^a	2^a
Stavudine (D4T)	1	1	1	1	1	2/3^a	2^a	2/3^a	2^a
b) Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
Efavirenz (EFV)	2^a	2^a	2^a	1 = DMPA; 2 = NET-EN^a	2^a	2/3^a	2^a	2/3^a	2^a
Etravirine (ETR)	1	1	1	1	1	2/3^a	2^a	2/3^a	2^a
Nevirapine (NVP)	2^a	2^a	2^a	1 = DMPA; 2 = NET-EN^a	2^a	2/3^a	2^a	2/3^a	2^a
Rilpivirine (RPV)	1	1	1	1	1	2/3^a	2^a	2/3^a	2^a
c) Protease inhibitors (PIs)
Ritonavir-boosted atazanavir (ATV/r)	2^a	2^a	2^a	1 = DMPA; 2 = NET-EN^a	2^a	2/3^a	2^a	2/3^a	2^a
Ritonavir-boosted lopinavir (LPV/r)	2^a	2^a	2^a	1 = DMPA; 2 = NET-EN^a	2^a	2/3^a	2^a	2/3^a	2^a
Ritonavir-boosted darunavir (DRV/r)	2^a	2^a	2^a	1 = DMPA; 2 = NET-EN^a	2^a	2/3^a	2^a	2/3^a	2^a
Ritonavir (RTV)	2^a	2^a	2^a	1 = DMPA; 2 = NET-EN^a	2^a	2/3^a	2^a	2/3^a	2^a
d) Integrase inhibitors
Raltegravir (RAL)	1	1	1	1	1	2/3^a	2^a	2/3^a	2^a

Condition

COC/P/CVR

CIC

POP

DMPA
NET-EN

LNG/ETG implants

Cu-IUD

LNG-IUD

Breastfeeding

a) < 6 weeks postpartum

2^a

3^a

2^a

b) ≥ 6 weeks to < 6 months (primarily breastfeeding)

c) ≥ 6 months postpartum

Postpartum
(non-breastfeeding women)

a) < 21 days

(i) without other risk factors for VTE

3^a

(ii) with other risk factors for VTE

4^a

b) ≥ 21 days to 42 days

(i) without other risk factors for VTE

2^a

(ii) with other risk factors for VTE

3^a

c) ≥ 42 days

Postpartum
(breastfeeding or non-breastfeeding women, including after caesarean section)

a) < 48 hours including insertion immediately after delivery of the placenta

not BF=1;
BF=2

b) ≥ 48 hours to < 4 weeks

c) ≥ 4 weeks

d) Puerperal sepsis

Superficial venous disorders

a) Varicose veins

b) Superficial venous thrombosis

2^a

Known dyslipidaemias without other known cardiovascular risk factors

2^a

1^a

2^a

STIs

a) Current purulent cervicitis or chlamydial infection or gonorrhoea

2^a

b) Other STIs (excluding HIV and hepatitis)

c) Vaginitis (including Trichomonas vaginalis and bacterial vaginosis)

d) Increased risk of STIs

2/3^a

HIV/AIDS

High risk of HIV

1^a

Asymptomatic or mild HIV clinical disease (WHO stage 1 or 2)

1^a

Severe or advanced HIV clinical disease (WHO stage 3 or 4)

1^a

2^a

Antiretroviral therapy

a) Nucleoside reverse transcriptase inhibitors (NRTIs)

Abacavir (ABC)

2/3^a

2^a

2/3^a

2^a

Tenofovir (TDF)

2/3^a

2^a

2/3^a

2^a

Zidovudine (AZT)

2/3^a

2^a

2/3^a

2^a

Lamivudine (3TC)

2/3^a

2^a

2/3^a

2^a

Didanosine (DDI)

2/3^a

2^a

2/3^a

2^a

Emtricitabine (FTC)

2/3^a

2^a

2/3^a

2^a

Stavudine (D4T)

2/3^a

2^a

2/3^a

2^a

b) Non-nucleoside reverse transcriptase inhibitors (NNRTIs)

Efavirenz (EFV)

2^a

1 = DMPA;
2 = NET-EN^a

2^a

2/3^a

2^a

2/3^a

2^a

Etravirine (ETR)

2/3^a

2^a

2/3^a

2^a

Nevirapine (NVP)

2^a

1 = DMPA;
2 = NET-EN^a

2^a

2/3^a

2^a

2/3^a

2^a

Rilpivirine (RPV)

2/3^a

2^a

2/3^a

2^a

c) Protease inhibitors (PIs)

Ritonavir-boosted atazanavir (ATV/r)

2^a

1 = DMPA;
2 = NET-EN^a

2^a

2/3^a

2^a

2/3^a

2^a

Ritonavir-boosted lopinavir (LPV/r)

2^a

1 = DMPA;
2 = NET-EN^a

2^a

2/3^a

2^a

2/3^a

2^a

Ritonavir-boosted darunavir (DRV/r)

2^a

1 = DMPA;
2 = NET-EN^a

2^a

2/3^a

2^a

2/3^a

2^a

Ritonavir (RTV)

2^a

1 = DMPA;
2 = NET-EN^a

2^a

2/3^a

2^a

2/3^a

2^a

d) Integrase inhibitors

Raltegravir (RAL)

2/3^a

2^a

2/3^a

2^a

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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Table 2.4Summary of changes from the fourth edition to the fifth edition of the MEC (changes are highlighted in bold)