Contraception Counseling
Patient-centered contraceptive decision-making
All Pathways
Family MedicineManagement
Contraception Selection & Counseling (CDC US-MEC)
Contraception Selection & Counseling (CDC US-MEC): Contraception Counseling → Assess Patient Preferences → Medical History Screen → Contraceptive Effect...
Pathway Overview
11 steps
Algorithm Steps
11 total
01Start 02Action Assess Patient Preferences
Key questions to ask
- Desire for future pregnancy (timing)
- Importance of efficacy vs convenience
- Preferences: hormonal vs non-hormonal
- Frequency of dosing tolerable
- STI protection needs
- Confidentiality concerns
03Action Medical History Screen
US-MEC Category assessment
- Current medications (enzyme inducers)
- Cardiovascular: HTN, migraine with aura, VTE history
- Metabolic: DM with vascular disease
- Hepatic: active liver disease
- Breast cancer history
- Postpartum status and breastfeeding
04Decision Contraceptive Effectiveness Tiers
Recommend most effective methods first
- Tier 1 (Most effective <1%): IUDs, implant, sterilization
- Tier 2 (Effective 4-7%): Injectable, pills, patch, ring
- Tier 3 (Less effective 13-27%): Condoms, diaphragm, withdrawal
05Action LARC Methods (Tier 1)
Long-acting reversible contraception
- Copper IUD (Paragard): 10 years, non-hormonal, heavier periods
- LNG-IUD (Mirena 8yr, Liletta 8yr, Kyleena 5yr): lighter/absent periods
- Implant (Nexplanon): 3 years, irregular bleeding common
- Same-day insertion encouraged
- No pelvic exam required before LARC (ACOG)
06Action Special Considerations
US-MEC guidance
- Migraine with aura: Avoid estrogen (US-MEC 4)
- HTN ≥160/100: Avoid CHC
- Breastfeeding <6 weeks: Avoid CHC
- VTE history: Avoid CHC, progestin OK
- Nulliparous: IUDs safe and recommended
07Action Quick Start Method
Start contraception today
- Can start any method any day if reasonably certain not pregnant
- Backup method (condoms) x 7 days for most methods
- No need to wait for menses
- Improves adherence and reduces unintended pregnancy
08Action Follow-Up
Reassess at visits
- CHC: BP check at 3 months, then annually
- IUD: String check at 1 month optional
- Depo: Every 11-13 weeks for injection
- Address side effects, method satisfaction
- Offer method change if not satisfied
09Action Short-Acting Hormonal (Tier 2)
Require regular use
- Combined pills: Take daily, many formulations
- Patch: Weekly, avoid if >90kg
- Ring (NuvaRing): Monthly, can remove for intercourse
- Injectable (Depo-Provera): Every 3 months, weight gain, bone loss
- Progestin-only pill: Daily at same time (stricter timing)
- Path rejoins step 06Shared downstream outcome
10Action Barrier & Other (Tier 3)
Require use with each act
- Male condom: Also protects against STIs
- Female condom: Can insert in advance
- Diaphragm/cap: Requires fitting, use with spermicide
- Fertility awareness: Requires training, partner cooperation
- Withdrawal: Better than nothing, 20% failure
11Action Emergency Contraception
Discuss at every visit
- Copper IUD: Most effective, insert within 5 days
- Ulipristal (ella): Rx, effective 120h, delay by BMI
- Levonorgestrel (Plan B): OTC, effective 72h, less effective if >75kg
- Advance prescription encouraged
- Path rejoins step 07Shared downstream outcome
Guideline Source
CDC US Medical Eligibility Criteria for Contraceptive Use
Clinical Safety Information
Clinical Decision Support — Not a Substitute for Clinical Judgment
Individual patient factors may require deviation from these recommendations.
Known Limitations
- Complete US-MEC tables not included - consult for complex cases
- Does not address contraception in adolescents specifically
- IUD insertion procedures not detailed
- Contraceptive failure rates simplified
- Does not address postpartum contraception timing in detail
Applicable Regions
USAUUKEU
AU: FSRH guidelines align closely
UK: FSRH UK-MEC equivalent criteria
US: CDC US-MEC 2024 criteria
Version 1Next review: 2027-01-01
Next steps
Finish the workflow by opening the most relevant calculator, then convert the session into a live account when you are ready.
Related Resources
Frequently Asked Questions
What is the Contraception Selection & Counseling (CDC US-MEC)?
The Contraception Selection & Counseling (CDC US-MEC) is a management clinical algorithm for Family Medicine. It provides a structured decision tree to guide clinical decision-making, based on CDC US Medical Eligibility Criteria for Contraceptive Use.
What guideline is the Contraception Selection & Counseling (CDC US-MEC) based on?
This algorithm is based on CDC US Medical Eligibility Criteria for Contraceptive Use (DOI: 10.15585/mmwr.rr6504a1).
What are the limitations of the Contraception Selection & Counseling (CDC US-MEC)?
Known limitations include: Complete US-MEC tables not included - consult for complex cases; Does not address contraception in adolescents specifically; IUD insertion procedures not detailed; Contraceptive failure rates simplified; Does not address postpartum contraception timing in detail. Individual patient factors may require deviation from these recommendations.
Get AI-Powered Analysis Alongside This Algorithm
In AttendMe.ai, the Contraception Selection & Counseling (CDC US-MEC) appears automatically when your clinical question matches — alongside evidence from 3M+ peer-reviewed articles.
Try AttendMe Free