Following Up on the CDC's Contraception Safety Guideline

We recently wrote about the CDC’s new publication, the U S. Medical Eligibility Criteria for Contraceptive Use, 2010, which outlines specific characteristics or medical conditions that may interfere with safe contraception use. The July issue of the journal Contraception follows up on this topic, featuring articles from CDC and WHO authors on contraception use and specific medical conditions as well as current research gaps.

The authors identify the following issues as needing further research, among several others:

• Long-term effects of Depo Provera on bone mineral density and any relevant race/ethnicity factors
• Effects of postpartum oral contraceptives on infant health and breastfeeding
• Whether IUD expulsion rates vary by type of birth a woman has had (i.e., if the IUD is more likely to be come out if a woman has a vaginal or cesarean birth)
• Whether the risk of blood clots (venous thromboembolism or VTE) is greater and whether oral contraceptive efficacy is lower in obese women
• Whether use of hormonal contraceptives worsens depressive disorders (including postpartum depression)

Other issues identified as needing further research include questions about contraceptive use and efficacy in women with cervical cancer, uterine fibroids, HIV/AIDS, inflammatory bowel disease and rheumatoid arthritis.

In a commentary on the problem of gaps in the existing evidence base on contraceptive safety, CDC and WHO representatives write:

Absence of evidence regarding contraceptive safety may be equated by women or their providers with absence of safety and lead to use of less effective methods. Alternatively, absence of evidence may be equated with absence of risk, resulting in use of methods which may potentially place these women at increased risk of adverse events or complications.

Other articles in the issue review topics such as IUD use by women with uterine fibroids and contraception use among women who have had bariatric (weight loss) surgery.