CDC: Updated contraception guidelines

CDC: Updated contraception guidelines | Image Credit: ©JPC-PROD - © JPC-PROD - stock.adobe.com.

The Centers for Disease Control and Prevention (CDC) has provided updated guidelines for contraception, addressing common issues with initiation and use of specific methods.¹

Contraception use is key for pregnancy prevention, with a significant association reported between same-day contraceptive initiation and reduced pregnancy risk.² One study reported pregnancy in 0.4% of same-day start users, and investigators recommended clinicians use their best clinical judgement when providing reproductive health care.

US Selected Practice Recommendations for Contraceptive Use, 2024 (US SPR) is a set of updated guidelines for providers to reference, detailing contraception provision and side effect management.¹ Using these recommendations, providers can reduce unnecessary barriers to contraception access and use.

Issues related to contraceptive use that clinicians can address using the document include necessary examinations and tests before initiation, needed follow-up, and how to address problems that may arise during use. These include missed pills and side effects such as bleeding irregularities.

US SPR is a companion document to US Medical Eligibility Criteria for Contraceptive Use, 2024 (US MEC), a document detailing safe contraceptive use for patients with certain medical complications or other characteristics. Global guidelines from the World Health Organization were consulted when developing both documents.

This document is an update to the 2016 US SPR, as the CDC has monitored new evidence available since the 2016 guidelines were published. Experts provided input on updating the guidelines during virtual scoping meetings held by the CDC on January 25 and January 26, 2022.

The recommendations focus on intrauterine device (IUD) placement and bleeding irregularity management. They noted that misoprostol is not recommended for routine use during IUD placement but may be beneficial when used in certain circumstances such as in patients with a recent failed placement.

Additionally, lidocaine may be beneficial for pain reduction during IUD placement. Bleeding irregularities may also occur during implant use, which patients should be consulted about beforehand. While these bleeding changes rarely cause harm, they may bring the patient discomfort.

Heavy bleeding is not common during implant use, but the risk of amenorrhea is increased among certain users. Continued use may or may not lead to a decrease in bleeding changes. When bleeding irregularities occur, an underlying health condition should be considered as the source. Patient goals such as continued implant use should be discussed.

Treatment options for bleeding irregularities include hormonal treatment, antifibrinolytic agents, nonsteroidal anti-inflammatory drugs, and selective estrogen receptor modulators. The implant should be removed whenever the patient desires, with counseling provided about other available contraceptive methods.

Medical treatment is not necessary in patients with amenorrhea. These patients should receive reassurance, but removal and counseling should still be provided if asked for by the patient.

Alongside these updates, the guidelines included new recommendations about testosterone use and the risk for pregnancy. Clinicians should mention that testosterone alone may not be effective for pregnancy protection among transgender, gender diverse, and nonbinary patients.

These patients should receive contraceptive counseling and services if they do not desire pregnancy. Additionally, subcutaneous depot medroxyprogesterone acetate should be offered as a self-administered injectable contraception based on recommendations published in 2021.

The CDC recommends clinicians use US SPR recommendations to determine how specific situations can be addressed. The US MEC may also be used to determine medical eligibility for certain contraceptive methods based on a patient’s demographic and medical characteristics, as the US MEC also received updates in 2024.

Reference:

1. Curtis KM, Nguyen AT, Tepper NK, et al. US selected practice recommendations for contraceptive use, 2024. MMWR Recomm Rep. 2024;73(No. RR-3):1–77. doi:10.15585/mmwr.rr7303a1
2. Krewson C. Study shows low pregnancy risk with same-day contraceptive initiation. Contemporary OB/GYN. June 25, 2024. Accessed August 6, 2024. https://www.contemporaryobgyn.net/view/study-shows-low-pregnancy-risk-with-same-day-contraceptive-initiation