CDC updates contraception recommendations
Selected practice recommendations and a medical eligibility statement include new advice on treatment and guidance on how to counsel patients while avoiding coercion, discrimination, and inequality.
New contraceptive recommendations offer substantive updates intended to remove barriers to contraception and support patient-centered decisions, according to the CDC.
The recommendations address common, yet sometimes complex, issues about specific contraceptive methods, replacing previous recommendations from 2016. Two documents, “U.S. Selected Practice Recommendations for Contraceptive Use, 2024” and “U.S. Medical Eligibility Criteria for Contraceptive Use, 2024,” were published in MMWR on Aug. 8.
Updated aspects include recommendations on intrauterine device (IUD) placement, bleeding irregularities from implants, testosterone and risk for pregnancy, and self-administration of injectable contraception. The recommendations are intended to serve as a source of evidence-based clinical practice guidance for clinicians, to remove unnecessary medical barriers to accessing and using contraception, and to support the provision of patient-centered counseling and services in a noncoercive manner, the CDC said.
The CDC said that routine use of misoprostol is not recommended for IUD placement, although it might be useful in certain circumstances. It newly recommended lidocaine, topical or as a paracervical block, for IUD placement due to its potential for reducing patient pain.
For patients who experience bleeding irregularities during use of implant use, certain treatment options may be considered. Hormonal treatment and antifibrinolytic agents might improve bleeding irregularities during use, although bleeding is likely to recur after treatment cessation. Nonsteroidal anti-inflammatory drugs for five to seven days and selective estrogen-receptor modulators for seven to 10 days may also be useful and may have effects that persist after treatment cessation, the CDC said.
Testosterone use might not prevent pregnancy among transgender, gender-diverse, and nonbinary persons with a uterus, the recommendations noted, so clinicians should offer contraceptive counseling and services to those who are at risk for and do not desire pregnancy.
Subcutaneous depot medroxyprogesterone acetate should be made available as an additional option for self-administered injectable contraception, the CDC said, noting that this recommendation was developed and published in 2021.
Updates in medical eligibility for contraception guidance include recommendations for patients with chronic kidney disease; revisions to the recommendations for patients who are breastfeeding, postpartum, or postabortion or are dealing with obesity, surgery, thrombolytic conditions, cardiovascular conditions, or other comorbidities; and new contraceptive methods, including new doses or formulations of combined oral contraceptives, contraceptive patches, vaginal rings, progestin-only pills, levonorgestrel IUDs, and vaginal pH modulators.
The CDC acknowledged that patients must have autonomy in contraceptive decision-making amid the context of historical and ongoing contraceptive coercion and reproductive mistreatment in the United States, especially among communities that have been marginalized.
Clinicians should acknowledge the structural systems that drive inequities, such as discrimination because of race, ethnicity, disability, sex, gender, and sexual orientation; work to mitigate harmful impacts; and recognize that clinician bias, unconscious or explicit, might affect contraceptive counseling and services.
“All persons seeking contraceptive care need access to appropriate counseling and services that support the person's values, goals, and reproductive autonomy,” the CDC stated. “Health care providers can support the contraceptive needs of all persons by using a person-centered framework and recognizing the many factors that influence individual decision-making about contraception.”