Conference Coverage

Updated Contraception Guidance for Primary Care: CDC Recommendations, Newer Methods, and Emergency Contraception

Edited by:
Ashton L. Stahl

Key Highlights

  • Inquire about pregnancy intention during every visit with pregnancy-capable patients.
  • Keep up to date on contraceptive options, safety, efficacy, and side effect management.
  • Use a patient-centered, shared decision-making approach in contraceptive counseling.
  • Provide adequate advance counseling on proper contraceptive use and potential side effects.
  • Offer advance prescriptions for ulipristal to all patients at risk for unintended pregnancy.

Primary care clinicians have an important role in ensuring that pregnancy-capable patients receive timely, individualized, and evidence-based contraceptive counseling. In this Practical Updates in Primary Care (PUPC) presentation, Jeffrey P. Levine, MD, MPH, and Anna Sliwowska, MD, emphasize that clinicians should proactively assess pregnancy intention at each visit and create space for patients to discuss reproductive health needs and goals. Rather than framing contraception as a separate or episodic discussion, the presenters encourage clinicians to make family planning needs part of routine primary care for reproductive-aged patients with a uterus who are at risk for pregnancy. This approach supports the broader clinical goals of improving patient satisfaction, adherence, and outcomes through shared decision-making and evidence-based counseling.

The presentation by Drs. Levine and Sliwowska underscore that contraceptive counseling should be personalized and non-coercive. Clinicians are encouraged to consider the patient’s preferences, values, concerns, and lifestyle alongside treatment options, risks and benefits, and clinician experience. Practical counseling considerations include menstrual bleeding changes, route of administration, ease of use, cost, privacy, effectiveness, hormonal vs nonhormonal preferences, and the method’s potential impact on sex or pleasure. When a patient has a strong preference for one method, Drs. Levine and Sliwowska recommend asking permission before discussing other options, simplifying the decision-making process, anticipating barriers to accurate and consistent use, and confirming understanding through strategies such as teach-back.

A central theme of the presentation is the adoption of the CDC’s 2024 US Medical Eligibility Criteria (MEC) for Contraceptive Use and US Selected Practice Recommendations (SPR) for Contraceptive Use. The US MEC helps clinicians determine whether specific contraceptive methods are safe for patients with particular medical conditions or characteristics. At the same time, the US SPR addresses practical implementation, including when to start a method, which exams or tests are needed, follow-up, missed or delayed pills, intrauterine device (IUD) placement medications, and management of irregular bleeding. The presenters emphasized that these tools could help remove unnecessary medical barriers, support reproductive autonomy, and guide shared decision-making. The 2024 updates include revised or new guidance related to postpartum care, postabortion care, deep vein thrombosis and/or pulmonary embolism, systemic lupus erythematosus, cirrhosis, liver tumors, sickle cell disease, solid organ transplant, high HIV risk, thrombosis-related conditions, chronic kidney disease, and newer contraceptive formulations.

The presentation also reviews newer methods and formulations, including the segesterone acetate/ethinyl estradiol vaginal ring, drospirenone 4-mg progestin-only pill, levonorgestrel/ethinyl estradiol patch, nonhormonal vaginal pH modulator, drospirenone/estetrol combined oral contraceptive, over-the-counter norgestrel oral contraceptive, a new inserter for the copper T IUD, and a newer, nonhormonal copper-releasing intrauterine system. Clinicians are also reminded to provide advance counseling on correct use and side effects, including individualized pain management counseling before IUD placement.

Emergency contraception remains an essential component of contraceptive care. Emergency contraceptive options include levonorgestrel emergency contraceptive pills, ulipristal acetate, as well as the copper IUD and LNG 52-mg IUD emergency contraception, which have the highest efficacy presented for IUDs. The presenters recommend advance prescriptions for ulipristal for patients at risk for unintended pregnancy.

Reference

Levine JP, Sliwowska A. An update on contraception for primary care providers. Presented at: Practical Updates in Primary Care; 2026. https://www.hmpglobalevents.com/pupc