Contraceptive use criteria updated.

Based on the latest clinical and epidemiological data, updated summary tables of medical eligibility criteria for contraceptive use are available at http://www.who.int/reproductive-health/publications/ RHR_00_2_medical_eligibility_criteria_3rd/index.htm. The tables, prepared to reflect recommendations made by an expert working group in October 2003, appear in the recently finalized third edition of the World Health Organization's Medical Eligibility Criteria for Contraceptive Use.

Of note, review of the scientific evidence led to revised guidance on the use of the intrauterine device (IUD). In general, the revisions treat the IUD more favorably than before. Although IUD use should not be initiated in women with pelvic inflammatory disease or in women with current purulent cervicitis, chlamydial infection, or gonorrhea, such women who already have an IUD can continue to use the method, and infection can be treated with an IUD in place. Likewise, women can generally continue using the IUD if they are at increased risk of sexually transmitted infections (including HIV), are HIV infected, or have AIDS. Initiation of IUD use is usually not recommended for women with AIDS who either are not receiving antiretroviral therapy or do not have clinical improvement while on such therapy.

Other noteworthy updates include the addition of a category entitled "known thrombogenic mutations" for which combined oral or injectable contraceptives should not be used. For another new category--"depressive disorders"--no restrictions exist for any contraceptive method, except for sterilization (for which caution is recommended). All hormonal contraceptives can generally be used or carry no restrictions for women with AIDS. Women using rifampicin and certain anticonvulsants can generally use combined injectable contraceptives now. Oral contraceptives and combined injectables can generally be used or carry no restrictions for women using griseofulvin. Finally, the tables have been updated to include three new contraceptive methods: patch, ring, and etonogestrel implants.