Curtis Kathryn M, Nguyen Antoinette T, Tepper Naomi K, Whiteman Maura K
Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, United States.
Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, United States.
Contraception. 2025 Jul 14:111015. doi: 10.1016/j.contraception.2025.111015.
In August 2024, the U.S. Centers for Disease Control and Prevention updated U.S. Medical Eligibility Criteria for Contraceptive Use (U.S. MEC), which provides recommendations for safe use of contraception for women with certain characteristics and medical conditions. This paper provides a summary of the evidence and context for new and updated U.S. MEC recommendations.
The 2024 U.S. MEC was updated through a rigorous, multi-year process of determining priorities that would have high impact on clinical care, conducting systematic reviews of the evidence, and considering perspectives of health care providers and patients on how the evidence could best support updated recommendations.
New U.S. MEC recommendations were added for chronic kidney disease, specifically for three subconditions: current nephrotic syndrome, hemodialysis, and peritoneal dialysis. Revisions were made to several existing recommendations, such as those for sickle cell disease, anticoagulant therapy use, various thrombogenic conditions, cirrhosis, liver tumors, solid organ transplantation, and intrauterine device placement in the postpartum period. Updated recommendations include those that reflect decreased safety concerns for some medical conditions (e.g., progestin-only contraception and some liver diseases) and increased safety concerns for others (e.g., combined hormonal contraception and depot medroxyprogesterone acetate for women with sickle cell disease). Recommendations for new contraceptive methods were added.
Evidence-based clinical guidelines can be used by health care providers to support patient-centered contraceptive counseling and services and remove unnecessary barriers to accessing and using contraception. Provider tools including a mobile app are available to help with implementation of the updated recommendations.
Keeping U.S. MEC up-to-date is critical for supporting contraceptive decision-making and improving access to contraception and reproductive health care. This includes new research to address current evidence gaps, rigorous methodology for continuous evidence identification and synthesis, state-of-the-art methods for guideline development, and a broad range of dissemination and implementation strategies.
2024年8月，美国疾病控制与预防中心更新了《美国避孕使用医学资格标准》（U.S. MEC），该标准为具有某些特征和医疗状况的女性安全使用避孕方法提供了建议。本文总结了新的和更新后的美国MEC建议的证据及背景。
2024年美国MEC通过一个严格的、多年的过程进行更新，该过程包括确定对临床护理有重大影响的优先事项、对证据进行系统评价，以及考虑医疗保健提供者和患者对证据如何能最好地支持更新建议的看法。
针对慢性肾病增加了新的美国MEC建议，特别是针对三个子情况：当前的肾病综合征、血液透析和腹膜透析。对一些现有建议进行了修订，如镰状细胞病、抗凝治疗使用、各种血栓形成情况、肝硬化、肝肿瘤、实体器官移植以及产后放置宫内节育器的建议。更新后的建议包括那些反映对某些医疗状况安全性担忧降低的建议（如仅使用孕激素避孕和某些肝脏疾病）以及对其他状况安全性担忧增加的建议（如镰状细胞病女性使用复方激素避孕和醋酸甲羟孕酮长效注射剂）。增加了对新避孕方法的建议。
医疗保健提供者可使用基于证据的临床指南来支持以患者为中心的避孕咨询和服务，并消除获取和使用避孕方法的不必要障碍。包括移动应用程序在内的提供者工具可用于帮助实施更新后的建议。
使美国MEC保持最新状态对于支持避孕决策以及改善避孕和生殖健康护理的可及性至关重要。这包括开展新研究以填补当前的证据空白、采用严格的方法持续识别和综合证据、采用最先进的指南制定方法，以及广泛的传播和实施策略。
