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Am Fam Physician. 2025;112(2):176-186

Related AFP Community Blog: The Loss of Foundational Contraceptive Expertise for the United States

Published online July 15, 2025.

This clinical content conforms to AAFP criteria for CME.

Author disclosure: Dr. Klein has no financial disclosures but served as a subject matter expert for the Centers for Disease Control and Prevention in the development of the 2024 US Medical Eligibility Criteria for Contraceptive Use and US Selected Practice Recommendations for Contraceptive Use. Drs. Forlini and Kremsreiter have no relevant financial relationships.

In 2024, the Centers for Disease Control and Prevention and the US Department of Health and Human Services Office of Population Affairs updated national guidelines on provision of quality contraceptive services and sexual and reproductive health care. New recommendations systematically promote care that is person-centered and accessible for all people. Contraceptive services may be addressed through a stepwise approach in which the clinician asks about an individual’s contraceptive preferences based on their needs, desires, and prior experiences and then collaboratively works with the patient to align methods with their values and preferences. The clinician should discuss all methods that can be used safely based on medical eligibility criteria regardless of method availability and defer the decision to the patient. Physical assessment includes in-office or self-reported blood pressure measurement before starting an estrogen-containing contraceptive or pelvic examination when inserting an intrauterine device. If it is reasonably certain that the patient is not pregnant, any contraceptive may be started immediately; otherwise, a nonintrauterine bridge method may be initiated with follow-up pregnancy testing. To reduce barriers, a 1-year supply of short-acting or injectable contraceptives may be prescribed, and telehealth may be incorporated. The Centers for Disease Control and Prevention supports advance provision of emergency contraceptives. New recommendations include pain control during intrauterine device insertion, management of bleeding irregularities related to contraception, updated eligibility criteria (eg, venous thromboembolism, kidney disease), and new methods (eg, progestin-only formulations). Expanded sexual and reproductive health care services, such as screening for cervical cancer or sexually transmitted infections, should be offered, but patient acceptance of these services is not required during contraception management.

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