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[World Health Organization (WHO) eligibility criteria for oral contraceptive use. Part 2] Criterios de la OMS de elegibilidad para el uso de anticonceptivos(segunda parte).
BOLETIN INFORMATIVO. 1996 Nov-Dec; (26):4-9.New medical criteria for IUDs and barrier methods defined by the World Health Organization in 1995 to reflect development of safer methods are presented. Health conditions are classified into four categories. Category 2 conditions need not restrict use of a method but should be considered when a method is chosen. Category 3 conditions require careful consideration of the gravity of the case, the availability of alternative methods, and access to emergency services, as well as careful follow-up. Many conditions that had been considered contraindications to IUD use are no longer regarded as risk factors with copper IUDs. Use is unrestricted for women over 20, smokers, the obese, lactating women, those with a history of preeclampsia, ectopic pregnancy, epilepsy, diabetes, and many other conditions. Age under 20 and nulliparity are category 2 conditions because of the risk of expulsion. Severe menstrual bleeding, under 48 hours postpartum, uterine-cervical abnormalities not deforming the uterus, and a few other conditions are in category 2. Category 3 conditions in which risks outweigh advantages include 48 hours to 4 weeks postpartum, benign gestational trophoblastic disorders, elevated risk of HIV/AIDS or HIV infection. Category 4 conditions precluding use of IUDs include pregnancy; puerperal sepsis or septic abortion; uterine abnormality incompatible with insertion; vaginal bleeding of unknown cause; gestational trophoblastic malignancy; cervical, endometrial, or ovarian cancer; pelvic tuberculosis; and sexually transmitted disease within three months. Almost all conditions are in category 1 and none are in category 4 for use of barrier methods, but their relatively high failure rates should be kept in mind. Allergy to latex is a category 3 condition for condoms and diaphragms and history of toxic shock syndrome is a category 3 for diaphragms.
[World Health Organization (WHO) eligibility criteria for contraceptive use] Criterios de la OMS de elegibilidad para el uso de anticonceptivos.
BOLETIN INFORMATIVO. 1996 Sep-Oct; (25):8-10.Two World Health Organization expert working groups reviewing eligibility criteria for use of various contraceptive methods defined new medical criteria which were published in 1995. Contraceptive usage has increased greatly in recent decades, but many couples have no access to modern methods, in part because of overly restrictive policies of family planning programs. The reduction of estrogen doses, development of progestin-only methods, widespread use of copper IUDs and declining use of nonmedicated IUDs, and results of clinical and epidemiological studies created a need for reexamination of prescription practices. The resulting four-part classification is based on evaluation of health risks and benefits, ranging from category 1 with no restrictions, through categories 2 and 3 in which advantages exceed risks or vice versa, to category 4 in which the risk is unacceptable and the method should not be used. The study concluded that many criteria restricting use of high estrogen OCs are not applicable to low dose combined OCs. Eligibility criteria for progestin-only methods are generally less restrictive than for combined OCs. Most of the medical conditions reviewed did not contraindicate use of IUDs. The advantages of contraceptive use generally exceeded the theoretical or proven risks associated with a method, regardless of the woman’s age. Vaginal bleeding of unknown cause was considered to correspond to category 3 or 4. No restrictions on use of any method studied existed for many specific medical conditions, such as thyroid disease or epilepsy. Clinical and laboratory examinations are unnecessary if the medical history is correctly recorded. Women using hormonal methods or IUDs who are at risk of contracting sexually transmitted diseases should be advised to use condoms in addition to the regular method.