Table 1.

Contraception Management in Transplant Recipients

Method	Advantages	Disadvantages	CDC Category (Uncomplicated)	CDC Category (Complicated)
Copper-T IUD	Most effective, long acting, reversible	Heavy menses	2	Initiation: 2 Continuation: 3
Progestin IUD	Most effective, long acting, reversible, decreased anemia	Irregular bleeding	2	Initiation: 2 Continuation: 3
Depot medroxyprogesterone acetate	Highly effective, decreased anemia	Decrease in BMD, irregular bleeding, possible cholestatic effect	2	2
Progestin implant	Most effective, long acting, no BMD decrease	Irregular bleeding	2	2
COC	Menstrual regulation, decreased anemia	Contraindicated in those with uncontrolled hypertension, active liver disease, and personal history of myocardial infarction, stroke, or DVT; first-pass liver metabolism; gastrointestinal disturbance may decrease absorption	2	4
Contraceptive patch	First-pass liver metabolism avoided	Higher circulating levels of estrogen; contraindicated in those with uncontrolled hypertension, active liver disease, and personal history of myocardial infarction, stroke, or DVT	2	4
Vaginal ring	First-pass liver metabolism avoided, lower circulating estrogen	Contraindicated in those with uncontrolled hypertension, active liver disease, and personal history of myocardial infarction, stroke, or DVT	2	4
Progestin-only pill		Less effective than COC; first-pass liver metabolism	2	2
Condoms	No drug interactions, protects from sexually transmitted diseases	Less effective	1	1
Cervical cap/diaphragm	No drug interactions	Less effective	1	1
Emergency contraception	Effective after sexual intercourse	Not effective as ongoing method	1	1

CDC Categories of medical eligibility criteria for contraceptive use: 1: a condition for which there is no restriction for use of the contraceptive method; 2: a condition for which the advantages of using the method generally outweigh the theoretical or proven risks; 3: a condition for which the theoretical or proven risks usually outweigh the advantages of using the method; 4: a condition that represents an unacceptable health risk if the method is used. BMD, bone mineral density; CDC, Centers for Disease Control and Prevention; COC, combined oral contraceptive; DVT, deep vein thrombosis; IUD, intrauterine device; Data from Centers for Disease Control and Prevention.¹¹