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Uterine fibroids 2 {1 if no uterine distortion and 4 if uterine distortion is present} 2 {1 if no uterine distortion and 4 if uterine distortion is present} Summary of recommendations for medical conditions added to the US Medical Eligibility Criteria for Contraceptive Use* Condition COC/P/R POP DMPA Implants LNG-IUD Cu-IUD Clarification History of bariatric surgery Δ Restrictive procedures: decrease storage capacity of the stomach (vertical banded gastroplasty, laparoscopic adjustable gastric band, laparoscopic sleeve gastrectomy) 1 1 1 1 1 1 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 Peripartum cardiomyopathy Δ 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) <6 mos 4 1 1 1 2 2 ≥6 mos 3 1 1 1 2 2 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 Rheumatoid arthritis On immunosuppressive therapy 2 1 2/3 • 1 Initiation: 2 Continuation: 1 Initiation: 2 Continuation: 1 DMPA use among women on long-term corticosteroid therapy with a history of, or risk factors for, nontraumatic fractures is classified as Category 3. Otherwise, DMPA use for women with rheumatoid arthritis is classified as Category 2. Not on immunosuppressive therapy 2 1 2 1 1 1

Inflammatory bowel disease (IBD) (ulcerative colitis, Crohn disease) 2/3 Δ 2 2 1 1 1 For women with mild IBD, with no other risk factors for VTE, the benefits of COC/P/R use generally outweigh the risks (Category 2). However, for women with IBD with increased risk for VTE (eg, those with active or extensive disease, surgery, immobilization, corticosteroid use, vitamin deficiencies, fluid depletion), the risks for COC/P/R use generally outweigh the benefits (Category 3). Solid organ transplantation Δ Complicated: graft failure (acute or chronic), rejection, cardiac allograft vasculopathy 4 2 2 2 Initiation: 3 Continuation: 2 Initiation: 3 Continuation: 2 Uncomplicated 2 • 2 2 2 2 2 Women with Budd-Chiari syndrome should not use COC/P/R because of the increased risk for thrombosis. Summary of additional changes to the US Medical Eligibility Criteria for Contraceptive Use Condition/contraceptive method Change Emergency contraceptive pills History of bariatric surgery, rheumatoid arthritis, inflammatory bowel disease, and solid organ transplantation were added to Appendix D (Classifications for Emergency Contraceptive Pills) and given a Category 1. Barrier methods For 6 conditions - history of bariatric surgery, peripartum cardiomyopathy, rheumatoid arthritis, endometrial hyperplasia, inflammatory bowel disease, and solid organ transplantation - the barrier methods are classified as Category 1. Sterilization In general, no medical conditions would absolutely restrict a person's eligibility for sterilization. Recommendations from the World Health Organization (WHO) Medical Eligibility Criteria for Contraceptive Use about specific settings and surgical procedures for sterilization are not included here. The guidance has been replaced with general text on sterilization. Other deleted items Guidance for combined injectables, levonorgestrel implants, and norethisterone enanthate has been removed because these methods are not currently available in the United States. Guidance for "blood pressure measurement unavailable" and "history of hypertension, where blood pressure CANNOT be evaluated (including hypertension in pregnancy)" has been removed. Unintended pregnancy and increased health risk

Guidance for combined injectables, levonorgestrel implants, and norethisterone enanthate has been removed because these methods are not currently available in the United States. Guidance for "blood pressure measurement unavailable" and "history of hypertension, where blood pressure CANNOT be evaluated (including hypertension in pregnancy)" has been removed. Unintended pregnancy and increased health risk The following conditions have been added to the WHO list of conditions that expose a woman to increased risk as a result of unintended pregnancy: history of bariatric surgery within the past 2 years, peripartum cardiomyopathy, and receiving a solid organ transplant within 2 years. WHO: World Health Organization; COC: combined oral contraceptive; P: combined hormonal contraceptive patch; R: combined hormonal vaginal ring; POP: progestin-only pill; DMPA: depot medroxyprogesterone acetate; LNG-IUD: levonorgestrel-releasing intrauterine device; Cu-IUD: copper intrauterine device; DVT: deep venous thrombosis; PE: pulmonary embolism; VTE: venous thromboembolism; IBD: inflammatory bowel disease. * For conditions for which classification changed for ≥1 methods or the condition description underwent a major modification, WHO conditions and recommendations appear in curly brackets. • Consult the clarification column for this classification. Δ Condition that exposes a women to increased risk as a result of unintended pregnancy. Reproduced from: US Medical Eligibility Criteria for Contraceptive Use, 2010. Available at: file://www.cdc.gov/Mmwr/preview/mmwrhtml/rr59e0528a1.htm .