Reproductive health: Clinical guidance and practice resources

U.S. medical eligibility criteria for contraceptive use, 2016

(Affirmation of Value, November 2016)

The updated U.S. Medical Eligibility Criteria for Contraception was developed by the Centers for Disease Control and Prevention and was reviewed and categorized as Affirmation of Value by the American Academy of Family Physicians (AAFP).

Key recommendations

The 2016 U.S. Medical Eligibility Criteria for Contraceptive Use (U.S. MEC) comprises recommendations for the use of specific contraceptive methods in individuals with certain medical conditions. These recommendations can be used when consulting with women, men and couples about their contraceptive choices. These recommendations should be used to inform contraceptive decisions and may not apply to the use of contraceptives for other purposes. Contraceptive methods are categorized for their appropriateness of use in a variety of medical conditions or circumstances.

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Use of a brief familial risk assessment tool is recommended for women with a relevant personal or family history or high-risk ancestry. When indicated, follow-up genetic counseling and testing can help guide care. Routine risk assessment, counseling or testing is not advised for women without associated risk factors.

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Biennial mammography is advised for women aged 40 to 74 years at average risk. Evidence remains insufficient to determine the balance of benefits and harms for screening women aged 75 years or older or for supplemental screening with ultrasound or MRI, including in women with dense breasts.

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Risk-reducing medications such as tamoxifen, raloxifene or aromatase inhibitors may be offered to women aged 35 and older who are at increased risk and at low risk for adverse effects. These medications are not advised for women who are not at increased risk for breast cancer.

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Evidence supports cervical cancer screening using cervical cytology and high-risk human papillomavirus testing. Screening is advised every three years with cytology for women aged 21 to 29 and, for women aged 30 to 65, cytology every three years, hrHPV testing alone every five years or co-testing every five years. Screening is not advised for women younger than 21, women older than 65 with adequate prior screening and no high-risk factors, or women who have had a hysterectomy with removal of the cervix and no history of high-grade precancerous lesions or cervical cancer.

Read the USPSTF recommendation.

Screening focuses on sexually active adolescents and adults, including pregnant persons. All sexually active women aged 24 or younger should be screened, as well as women aged 25 or older who are at increased risk for infection. Evidence is insufficient to assess the balance of benefits and harms of screening in men.

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For asymptomatic adolescents and adults, including pregnant persons, routine population-based serologic screening is not advised. Available evidence indicates that potential harms outweigh benefits in individuals without known signs or symptoms of genital herpes.

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Behavioral counseling interventions are advised for sexually active adolescents and adults at increased risk for STIs. Evidence shows a moderate net benefit in reducing the likelihood of acquiring STIs.

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Screening is advised for asymptomatic adolescents and adults at increased risk. Identifying chronic hepatitis B virus infection supports timely management and helps prevent long-term, liver-related complications.

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Screening for intimate partner violence is advised for adolescents and adults who are pregnant or postpartum and women of reproductive age, with referral to multicomponent interventions when indicated. Evidence is insufficient to assess the balance of benefits and harms of screening for caregiver abuse or neglect in older or vulnerable adults.

Read the USPSTF recommendation.

Grade: D recommendation

The American Academy of Family Physicians (AAFP) recommends against screening pelvic exams in asymptomatic women. (2017)

Note: The AAFP’s recommendation differs from the USPSTF. The USPSTF determined there was insufficient evidence to assess the benefits and harms of performing screening pelvic examination in asymptomatic women for the early detection and treatment of certain gynecologic conditions. The USPSTF’s review did not include screening for ovarian cancer, cervical cancer, gonorrhea or chlamydia, as these are already covered by other USPSTF recommendations. Yet malignancy and pelvic inflammatory disease are the leading gynecologic causes of morbidity and mortality in women. Screening for other conditions that have limited effect on morbidity or mortality are unlikely to provide substantial benefit. There is evidence of harms for performing screening pelvic exams in asymptomatic women due to the increased risk of invasive testing and unnecessary treatment. Given the low likelihood of benefit and the increased risk of harm, the AAFP recommends against screening pelvic exams.