Medical Eligibility Criteria for
Progestin-Only Injectables

Ask the client the questions below about known medical conditions. Examinations and tests are not necessary. If she answers "no" to all of the questions, then she can start progestin-only injectables if she wants. If she answers "yes" to a question, follow the instructions. In some cases she can still start progestin-only injectables.

1.    Are you breastfeeding a baby less than 6 months old?

NO    YES She can start using progestin-only injectables as soon as 6 weeks after childbirth (see Fully or nearly fully breastfeeding or Partially breastfeeding).

2.    Do you have severe cirrhosis of the liver, a liver infection, or liver tumor? (Are her eyes or skin unusually yellow? [signs of jaundice])

NO    YES If she reports serious active liver disease (jaundice, active hepatitis, severe cirrhosis, liver tumor), do not provide progestin-only injectables. Help her choose a method without hormones.

3.    Do you have high blood pressure?

NO    YES If you cannot check blood pressure and she reports having high blood pressure in the past, provide progestin-only injectables.

Check her blood pressure if possible:

• If she is currently being treated for high blood pressure and it is adequately controlled, or her blood pressure is below 160/100 mm Hg, provide progestin-only injectables.
• If systolic blood pressure is 160 mm Hg or higher or diastolic blood pressure 100 or higher, do not provide progestin-only injectables. Help her choose another method without estrogen.

4.    Have you had diabetes for more than 20 years or damage to your arteries, vision, kidneys, or nervous system caused by diabetes?

NO    YES Do not provide progestin-only injectables. Help her choose another method without estrogen.

5.    Have you ever had a stroke, blood clot in your legs or lungs, heart attack, or other serious heart problems?

NO    YES If she reports heart attack, heart disease due to blocked or narrowed arteries, or stroke, do not provide progestin-only injectables. Help her choose another method without estrogen. If she reports a current blood clot (not superficial clots), and she is not on anticoagulant therapy, help her choose a method without hormones.

6.    Do you have vaginal bleeding that is unusual for you?

NO    YES If she has unexplained vaginal bleeding that suggests pregnancy or an underlying medical condition, progestin-only injectables could make diagnosis and monitoring of any treatment more difficult. Help her choose a method to use while being evaluated and treated (but not implants or a copper-bearing or hormonal IUD). After treatment, re-evaluate for use of progestin-only injectables.

7.    Do you have or have you ever had breast cancer?

NO    YES Do not provide progestin-only injectables. Help her choose a method without hormones.

8.    Do you have several conditions that could increase your chances of heart disease (coronary artery disease) or stroke, such as high blood pressure and diabetes?

NO    YES Do not provide progestin-only injectables. Help her choose another method without estrogen.

Be sure to explain the health benefits and risks and the side effects of the method that the client will use. Also, point out any conditions that would make the method inadvisable, when relevant to the client.