WHO Medical Eligibility Criteria

Medical eligibility criteria are evidence-based categories that state whether a patient with a given medical condition or characteristic can safely use a particular contraceptive method. They grade each condition and method pair into four categories and allow a clinician to match methods to medical risk quickly and consistently. The current edition is the sixth, published in 2025.

The four categories.

Initiation versus continuation. For some conditions the category differs for starting a method versus continuing one already in use, for example new breast cancer, new pelvic infection or an IUD user who develops a sexually transmitted infection.

Key category 4 conditions for combined hormonal methods.

• Under 21 days postpartum (not breastfeeding) and under 6 weeks postpartum (breastfeeding).

• Age 35 or more and smoking 15 or more cigarettes daily.

• Blood pressure systolic 160 mmHg or more or diastolic 100 mmHg or more, or hypertension with vascular disease.

• Current or past VTE, known thrombogenic mutations, major surgery with prolonged immobilisation.

• Ischaemic heart disease, stroke, complicated valvular heart disease.

• Migraine with aura at any age.

• Current breast cancer.

• Diabetes with nephropathy, retinopathy, neuropathy or other vascular disease, or diabetes of more than 20 years' duration (category 3 or 4 by severity).

• Severe decompensated cirrhosis, hepatocellular adenoma, malignant liver tumour.

• Systemic lupus erythematosus with positive or unknown antiphospholipid antibodies.

Key category 4 conditions for IUDs (initiation).

• Pregnancy.

• Puerperal sepsis; immediately after septic abortion.

• Current pelvic inflammatory disease; current purulent cervicitis, chlamydia or gonorrhoea.

• Unexplained vaginal bleeding before evaluation.

• Cervical or endometrial cancer awaiting treatment; gestational trophoblastic disease with persistently raised hCG or malignant disease.

• Uterine fibroids or anomalies distorting the cavity.

• Known pelvic tuberculosis.

• Current breast cancer, for the levonorgestrel IUD.

Progestogen-only methods. Most conditions are category 1 or 2. Current breast cancer is category 4. Category 3 conditions include past breast cancer with no evidence of disease for 5 years, severe decompensated cirrhosis, hepatocellular adenoma or malignant tumour, and positive antiphospholipid antibodies. DMPA is category 3 in multiple cardiovascular risk factors and hypertension of 160/100 mmHg or more.

Applying the categories.

• Take a focused history covering age, postpartum status, breastfeeding, smoking, blood pressure, VTE, migraine, cardiovascular disease, diabetes, liver disease, cancer, HIV and drug treatment.

• Measure blood pressure before combined methods.

• Identify the most restrictive category the patient has for each method.

• Where several conditions coexist, the overall risk may exceed that of any single condition.

Category 3 decisions. Use a category 3 method only after explaining the risks, when other methods are unavailable or unacceptable, and with planned follow up. Document the reason.

Drug interactions. Rifampicin and rifabutin, and the enzyme-inducing antiseizure drugs, place combined pills, progestin-only pills and combined patch and ring at category 3. Implants are category 2. DMPA and IUDs remain category 1.

HIV. All methods are category 1 or 2 for people living with HIV who are clinically well, with the exception of IUD initiation in severe or advanced HIV disease (category 3).

Common errors.

• Treating category 2 as a contraindication.

• Missing the postpartum restrictions on combined methods.

• Not reassessing eligibility when new conditions arise, such as a new hypertension diagnosis or migraine with aura.

• Applying combined method restrictions to progestogen-only methods.

Updates. Categories change as evidence develops. Use the current edition and recheck categories for postpartum, breastfeeding, HIV and drug interactions.

Referral and escalation. Refer patients with category 3 or 4 conditions for most methods, or complex multimorbidity, for specialist review. Provide condoms or another eligible interim method meanwhile.