Megan Cohen, MD, MPH, outlines 2024 CDC contraception guidelines

In a recent interview with Contemporary OB/GYN, Megan Cohen, MD, MPH, assistant professor in the Division of Complex Family Planning at Emory University School of Medicine, provided a comprehensive overview of the 2024 updates to the Centers for Disease Control and Prevention’s (CDC) contraceptive guidelines.

The discussion focused on the Medical Eligibility Criteria (MEC) and Selected Practice Recommendations (SPR). The updates reflect a shift toward more inclusive, patient-centered reproductive health care, with an emphasis on autonomy, shared decision-making, and gender-neutral language. A notable aspect of this update was the inclusion of patient representatives in the guideline development process—an important step toward ensuring that real-world experiences inform clinical recommendations.

Key clinical changes in the MEC included revised categorizations for contraceptive use in individuals with certain medical conditions. One significant update involves the risk of venous thromboembolism in users of Depo-Provera (DMPA), particularly in those with a history of deep vein thrombosis or pulmonary embolism. For these individuals, DMPA use was upgraded from a Category 2 where benefits generally outweigh risks to Category 3 where risks usually outweigh benefits, whereas the classifications for other progestin-only methods such as implants and levonorgestrel IUDs remained unchanged.

Newly added to the MEC were considerations for people with chronic kidney disease, including subcategories for nephrotic syndrome and those on dialysis. Sickle cell disease also received a separate category based on emerging evidence linking it with increased clotting risk. As a result, combined hormonal contraceptives were reclassified as Category 4, described as an unacceptable health risk, for patients with this condition.

The SPR updates focused on improving clinical practice. Revisions included updated management strategies for bleeding irregularities in implant users, guidance on the use of medications during IUD placement, and counseling considerations for transgender and non-binary individuals, particularly regarding the misconception that testosterone use provides contraceptive protection. Additionally, the guidelines incorporated an interim update on the use of subcutaneous DMPA.

Cohen also addressed the uncertain future of these guidelines. Although typically updated every few years, the CDC team responsible for the MEC and SPR has been disbanded. While the 2024 update was completed before this change, the loss of dedicated expertise raises concerns about the sustainability of future revisions, especially as new contraceptive methods and data continue to emerge. Nonetheless, Dr. Cohen expressed hope that efforts will continue to ensure up-to-date, evidence-based guidance remains available for providers and patients alike.

No relevant disclosures

Reference

Cohen MA. This Just In! 2024 CDC Contraceptive Recommendations. Presented at: 2025 ACOG Clinical and Scientific Meeting. May 16-18, 2025. Minneapolis, Minnesota.