Serfaty D
Hôpital St Louis, 75010, Paris, France.
J Gynecol Obstet Hum Reprod. 2019 May;48(5):297-307. doi: 10.1016/j.jogoh.2019.02.006. Epub 2019 Feb 20.
The choice of contraceptive methods has considerably increased over recent years. However, all available methods are not appropriate for all women, especially those with medical conditions or individual characteristics in whom any pregnancy, particularly unintended pregnancy, is at higher risk. The safety of contraception is crucial for these women and evidence-based guidance to help healthcare providers choosing a suitable method has been published. The aim of our review is to make an update on the main contraceptive contraindications.
The World Health Organisation Medical Eligibility Criteria for Contraceptive Use (WHO-MEC) published in 2015 are referred to throughout this review. The rationale behind the recommendations for women with cardiovascular, rheumatic, neurologic, gynaecological or endocrine disorders was first analysed. The national adaptations of the WHO-MEC, especially the French, British, and American ones, were then scrutinized.
Overall, the MECs considered tend to provide the same recommendations. However, there are some noticeable differences that may be useful to know. Hence, for a given condition, differences in categorisation have been noticed where limited or controversial scientific evidence relating to this condition exists, especially regarding hormonal contraceptives. Some medical conditions or characteristics, included in some MECs but not in others, have also been identified.
MECs represent valuable tools to help clinicians to prescribe the most acceptable and safe contraceptive method for each individual woman. Although it may be useful to consult different MECs for some complex conditions, prescribers should always bear in mind that these MECs are only guidelines and that their clinical judgment should always prevail.
近年来，避孕方法的选择大幅增加。然而，并非所有可用方法都适用于所有女性，尤其是那些有健康问题或个人特征的女性，她们怀孕的风险更高，尤其是意外怀孕。避孕安全对这些女性至关重要，已发布基于证据的指南以帮助医疗保健提供者选择合适的方法。我们综述的目的是更新主要的避孕禁忌证。
本综述通篇参考了2015年发布的世界卫生组织《避孕方法医学适用标准》（WHO-MEC）。首先分析了针对患有心血管、风湿、神经、妇科或内分泌疾病女性的建议背后的基本原理。然后仔细审查了WHO-MEC的各国改编版本，尤其是法国、英国和美国的版本。
总体而言，所考虑的医学适用标准往往提供相同的建议。然而，存在一些值得注意的差异，了解这些差异可能会有所帮助。因此，对于某一特定情况，在存在与该情况相关的有限或有争议的科学证据时，尤其是关于激素避孕法，已注意到分类上的差异。还确定了一些医学状况或特征，它们在某些医学适用标准中有，但在其他标准中没有。
医学适用标准是帮助临床医生为每位女性开出最可接受和安全的避孕方法的宝贵工具。尽管对于某些复杂情况参考不同的医学适用标准可能有用，但开处方者应始终牢记，这些医学适用标准只是指南，临床判断应始终占主导地位。
