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Age Menarche to <40 yrs = 1 Menarche to <18 yrs = 1 Menarche to <18 yrs = 2 Menarche to <18 yrs = 1 Menarche to <20 yrs = 2 Menarche to <20 yrs = 2 ≥40 yrs = 2 18-45 yrs = 1 18-45 yrs = 1 18-45 yrs = 1 ≥20 yrs = 1 ≥20 yrs = 1 >45 yrs = 1 >45 yrs = 2 >45 yrs = 1

Postpartum (nonbreastfeeding women) a. <21 days 4 1 1 1 b. 21 days to 42 days i. With other risk factors for VTE (such as age ≥35 years, previous VTE, thrombophilia, immobility, transfusion at delivery, BMI ≥30, postpartum hemorrhage, postcesarean delivery, preeclampsia or smoking) 3 Δ 1 1 1 ii. Without other risk factors for VTE 2 1 1 1 c. >42 days 1 1 1 1

Postpartum (breastfeeding women ◊ ) a. <21 days 4 2 2 2 b. 21 to <30 days i. With other risk factors for VTE (such as age ≥35 years, previous VTE, thrombophilia, immobility, transfusion at delivery, BMI ≥30 kg/m 2 , postpartum hemorrhage, postcesarean delivery, preeclampsia or smoking) 3 Δ 2 2 2 ii. Without other risk factors for VTE 3 2 2 2 c. 30 to 42 days i. With other risk factors for VTE (such as age ≥35 years, previous VTE, thrombophilia, immobility, transfusion at delivery, BMI ≥30, postpartum hemorrhage, postcesarean delivery, preeclampsia or smoking) 3 Δ 1 1 1 ii. Without other risk factors for VTE 2 1 1 1 d. >42 days 2 1 1 1

Postpartum (breastfeeding or nonbreastfeeding women, including post-Cesarean section) a. <10 min after delivery of the placenta 2 1 b. 10 min after delivery of the placenta to <4 wks 2 2 c. ≥4 wks 1 1 d. Puerperal sepsis 4 4

History of bariatric surgery § a. Restrictive procedures: decrease storage capacity of the stomach (vertical banded gastroplasty, laparoscopic adjustable gastric band, laparoscopic sleeve gastrectomy) 1 1 1 1 1 1 b. Malabsorptive procedures: decrease absorption of nutrients and calories by shortening the functional length of the small intestine (Roux-en-Y gastric bypass, biliopancreatic diversion) COCs: 3 P/R: 1 3 1 1 1 1 Cardiovascular disease

Hypertension a. Adequately controlled hypertension 3* 1* 2* 1* 1 1 b. Elevated blood pressure levels (properly taken measurements) i. Systolic 140 to 159 mmHg or diastolic 90 to 99 mmHg 3 1 2 1 1 1 ii. Systolic ≥160 mmHg or diastolic ≥100 mmHg § 4 2 3 2 2 1 c. Vascular disease 4 2 3 2 2 1

Deep venous thrombosis (DVT)/pulmonary embolism (PE) a. History of DVT/PE, not on anticoagulant therapy i. Higher risk for recurrent DVT/PE (≥1 risk factors) History of estrogen-associated DVT/PE Pregnancy-associated DVT/PE Idiopathic DVT/PE Known thrombophilia, including antiphospholipid syndrome Active cancer (metastatic, on therapy, or within 6 mos after clinical remission), excluding non-melanoma skin cancer History of recurrent DVT/PE 4 2 2 2 2 1 ii. Lower risk for recurrent DVT/PE (no risk factors) 3 2 2 2 2 1 b. Acute DVT/PE 4 2 2 2 2 2 c. DVT/PE and established on anticoagulant therapy for at least 3 mos i. Higher risk for recurrent DVT/PE (≥1 risk factors) Known thrombophilia, including antiphospholipid syndrome Active cancer (metastatic, on therapy, or within 6 mos after clinical remission), excluding non-melanoma skin cancer History of recurrent DVT/PE 4* 2 2 2 2 2 ii. Lower risk for recurrent DVT/PE (no risk factors) 3* 2 2 2 2 2 d. Family history (first-degree relatives) 2 1 1 1 1 1 e. Major surgery i. With prolonged immobilization 4 2 2 2 2 1 ii. Without prolonged immobilization 2 1 1 1 1 1 f. Minor surgery without immobilization 1 1 1 1 1 1

Peripartum cardiomyopathy § a. Normal or mildly impaired cardiac function (New York Heart Association Functional Class I or II: patients with no limitation of activities or patients with slight, mild limitation of activity) i. <6 mos 4 1 1 1 2 2 ii. ≥6 mos 3 1 1 1 2 2 b. Moderately or severely impaired cardiac function (New York Heart Association Functional Class III or IV: patients with marked limitation of activity or patients who should be at complete rest) 4 2 2 2 2 2 Rheumatic diseases

Systemic lupus erythematosus § Initiation Continuation Initiation Continuation a. Positive (or unknown) antiphospholipid antibodies 4 3 3 3 3 3 1 1 b. Severe thrombocytopenia 2 2 3 2 2 2* 3* 2* c. Immunosuppressive treatment 2 2 2 2 2 2 2 1 d. None of the above 2 2 2 2 2 2 1 1

Rheumatoid arthritis Initiation Continuation Initiation Continuation a. On immunosuppressive therapy 2 1 2/3* 1 2 1 2 1 b. Not on immunosuppressive therapy 2 1 2 1 1 1 Neurologic conditions

Headaches Initiation Continuation Initiation Continuation Initiation Continuation Initiation Continuation Initiation Continuation a. Non-migrainous (mild or severe) 1* 2* 1* 1* 1* 1* 1* 1* 1* 1* 1* b. Migraine i. Without aura - Age <35 yrs 2* 3* 1* 2* 2* 2* 2* 2* 2* 2* 1* - Age ≥35 yrs 3* 4* 1* 2* 2* 2* 2* 2* 2* 2* 1* ii. With aura (at any age) 4* 4* 2* 3* 2* 3* 2* 3* 2* 3* 1*

Vaginal bleeding patterns Initiation Continuation a. Irregular pattern without heavy bleeding 1 2 2 2 1 1 1 b. Heavy or prolonged bleeding (includes regular and irregular patterns) 1* 2* 2* 2* 1* 2* 2*

Breast disease a. Undiagnosed mass 2* 2* 2* 2* 2 1 b. Benign breast disease 1 1 1 1 1 1 c. Family history of cancer 1 1 1 1 1 1 d. Breast cancer § i. Current 4 4 4 4 4 1 ii. Past and no evidence of current disease for 5 yrs 3 3 3 3 3 1

Anatomical abnormalities a. Distorted uterine cavity (any congenital or acquired uterine abnormality distorting the uterine cavity in a manner that is incompatible with IUD insertion) 4 4 b. Other abnormalities (including cervical stenosis or cervical lacerations) not distorting the uterine cavity or interfering with IUD insertion 2 2

Pelvic inflammatory disease (PID) a. Past PID (assuming no current risk factors of STIs) Initiation Continuation Initiation Continuation i. With subsequent pregnancy 1 1 1 1 1 1 1 1 ii. Without subsequent pregnancy 1 1 1 1 2 2 2 2 b. Current PID 1 1 1 1 4 2* 4 2*

STIs Initiation Continuation Initiation Continuation a. Current purulent cervicitis or chlamydial infection or gonorrhea 1 1 1 1 4 2* 4 2* b. Other STIs (excluding HIV and hepatitis) 1 1 1 1 2 2 2 2 c. Vaginitis (including Trichomonas vaginalis and bacterial vaginosis) 1 1 1 1 2 2 2 2 d. Increased risk for STIs 1 1 1 1 2/3* 2 2/3* 2

AIDS § 1 1 1 1 3 2 3 2* NOTE: If on treatment, drug interactions might exist between hormonal contraceptives, including LNG-IUD, and antiretroviral drugs; refer to the section on drug interactions below as there may be limitations to use of the method. 2 2 2 2 Other infections

Tuberculosis § Initiation Continuation Initiation Continuation a. Nonpelvic 1* 1* 1* 1* 1 1 1 1 b. Pelvic 1* 1* 1* 1* 4 3 4 3 If on treatment, see Drug interactions section below

Diabetes a. History of gestational disease 1 1 1 1 1 1 b. Nonvascular disease i. Noninsulin-dependent 2 2 2 2 2 1 ii. Insulin-dependent § 2 2 2 2 2 1 c. Nephropathy/retinopathy/ neuropathy § 3/4* 2 3 2 2 1 d. Other vascular disease or diabetes of >20 yrs' duration § 3/4* 2 3 2 2 1

Solid organ transplantation § Initiation Continuation Initiation Continuation a. Complicated: graft failure (acute or chronic), rejection, cardiac allograft vasculopathy 4 2 2 2 3 2 3 2 b. Uncomplicated 2* 2 2 2 2 2 Drug interactions

Antiretroviral therapy (see appendix M) Initiation Continuation Initiation Continuation a. Nucleoside reverse transcriptase inhibitors (NRTIs) 1* 1 1 1 2/3* 2* 2/3* 2* b. Non-nucleoside reverse transcriptase inhibitors (NNRTIs) 2* 2* 1 2* 2/3* 2* 2/3* 2* c. Ritonavir-boosted protease inhibitors 3* 3* 1 2* 2/3* 2* 2/3* 2*

Antimicrobial therapy a. Broad-spectrum antibiotics 1 1 1 1 1 1 b. Antifungals 1 1 1 1 1 1 c. Antiparasitics 1 1 1 1 1 1 d. Rifampicin or rifabutin therapy 3* 3* 1 2* 1 1 COC: combined oral contraceptive; P: combined hormonal contraceptive patch; R: combined hormonal vaginal ring; POP: progestin-only pill; DMPA: depot medroxyprogesterone acetate; IUD: intrauterine device; LNG-IUD: levonorgestrel-releasing IUD; Cu-IUD: copper IUD; BMI: body mass index (weight [kg]/height [m 2 ]); DVT: deep venous thrombosis; VTE: venous thromboembolism; CHC: combined hormonal contraceptive; PE: pulmonary embolism; hCG: human chorionic gonadotropin; PID: pelvic inflammatory disease; STI: sexually transmitted infection; HIV: human immunodeficiency virus; AIDS: acquired immunodeficiency syndrome; NRTI: nucleoside reverse transcriptase inhibitor; NNRTI: non-nucleoside reverse transcriptase. * Consult the appendix for this contraceptive method for a clarification to this classification. Δ Clarification: For women with other risk factors for VTE, these risk factors might increase the classification to a "4"; for example, smoking, deep venous thrombosis/pulmonary embolism, known thrombogenic mutations, and peripartum cardiomyopathy. ◊ The breastfeeding recommendations are divided by month in US Medical Eligibility Criteria for Contraceptive Use, 2010 . They have been divided by days for purposes of integration with the postpartum recommendations. § Condition that exposes a woman to increased risk as a result of unintended pregnancy. ¥ Some studies suggest that women using progestin-only injectable contraception might be at increased risk for HIV acquisition; other studies do not show this association. CDC reviewed all available evidence and agreed that the data were not sufficiently conclusive to change current guidance. However, because of the inconclusive nature of the body of evidence on possible increased risk for HIV acquisition, women using progestin-only injectable contraception should be strongly advised to also always use condoms (male or female) and take other HIV preventive measures. References: Update to CDC's U.S. Medical Eligibility Criteria for Contraceptive Use, 2010: Revised Recommendations for the Use of Contraceptive Methods During the Postpartum Period. MMWR Morb Mortal Wkly Rep 2011; 60:878.

COC: combined oral contraceptive; P: combined hormonal contraceptive patch; R: combined hormonal vaginal ring; POP: progestin-only pill; DMPA: depot medroxyprogesterone acetate; IUD: intrauterine device; LNG-IUD: levonorgestrel-releasing IUD; Cu-IUD: copper IUD; BMI: body mass index (weight [kg]/height [m 2 ]); DVT: deep venous thrombosis; VTE: venous thromboembolism; CHC: combined hormonal contraceptive; PE: pulmonary embolism; hCG: human chorionic gonadotropin; PID: pelvic inflammatory disease; STI: sexually transmitted infection; HIV: human immunodeficiency virus; AIDS: acquired immunodeficiency syndrome; NRTI: nucleoside reverse transcriptase inhibitor; NNRTI: non-nucleoside reverse transcriptase. * Consult the appendix for this contraceptive method for a clarification to this classification. Δ Clarification: For women with other risk factors for VTE, these risk factors might increase the classification to a "4"; for example, smoking, deep venous thrombosis/pulmonary embolism, known thrombogenic mutations, and peripartum cardiomyopathy. ◊ The breastfeeding recommendations are divided by month in US Medical Eligibility Criteria for Contraceptive Use, 2010 . They have been divided by days for purposes of integration with the postpartum recommendations. § Condition that exposes a woman to increased risk as a result of unintended pregnancy. ¥ Some studies suggest that women using progestin-only injectable contraception might be at increased risk for HIV acquisition; other studies do not show this association. CDC reviewed all available evidence and agreed that the data were not sufficiently conclusive to change current guidance. However, because of the inconclusive nature of the body of evidence on possible increased risk for HIV acquisition, women using progestin-only injectable contraception should be strongly advised to also always use condoms (male or female) and take other HIV preventive measures. References: Update to CDC's U.S. Medical Eligibility Criteria for Contraceptive Use, 2010: Revised Recommendations for the Use of Contraceptive Methods During the Postpartum Period. MMWR Morb Mortal Wkly Rep 2011; 60:878. Update to CDC's U.S. Medical Eligibility Criteria for Contraceptive Use, 2010: Revised Recommendations for the Use of Hormonal Contraception Among Women at High Risk for HIV Infection or Infected with HIV. MMWR Morb Mortal Wkly Rep 2012; 61:449.

Update to CDC's U.S. Medical Eligibility Criteria for Contraceptive Use, 2010: Revised Recommendations for the Use of Contraceptive Methods During the Postpartum Period. MMWR Morb Mortal Wkly Rep 2011; 60:878. Update to CDC's U.S. Medical Eligibility Criteria for Contraceptive Use, 2010: Revised Recommendations for the Use of Hormonal Contraception Among Women at High Risk for HIV Infection or Infected with HIV. MMWR Morb Mortal Wkly Rep 2012; 61:449. Reproduced with permission from: US Medical Eligibility Criteria for Contraceptive Use 2010, with data adapted from the World Health Organization Medical Eligibility Criteria for Contraceptive Use, 4th edition.