Expanding contraceptive options: A scoping review of medically approved contraceptive methods that are not in the WHO Medical Eligibility Criteria

Objectives

The World Health Organization’s (WHO) Medical Eligibility Criteria for contraceptive use (MEC) provides recommendations on the safety and efficacy of a range of contraceptive methods for users with various medical conditions. However, there are methods with medical regulatory agency approval that are not included in WHO guidance. Our objectives were to evaluate the evidence on methods that have regulatory approval for use in any member state, but which are not included in the MEC 2015, and to determine whether the evidence should be systematically reviewed to inform possible inclusion in a new WHO guideline.

Study design

We conducted a scoping review of experimental studies found through two bibliographic databases (PubMed, Embase) from database inception to December 2023. Two reviewers screened abstracts and full texts to determine eligibility based on a priori inclusion and exclusion criteria; one additional reviewer resolved conflicts. Reviewers extracted data on method safety, efficacy, and acceptability using a standardized tool.

Results

We identified three methods that met our review criteria: ormeloxifene, quinestrol-containing contraception, and mifepristone for emergency contraception (EC). Our initial search strategies yielded 386 total results. Five publications related to ormeloxifene, five to quinestrol-containing contraception, and 10 to mifepristone for EC were included. The data on these methods was highly variable.

Conclusion

Rigorous systematic reviews of the evidence on safety, efficacy and dosage of ormeloxifene, quinestrol-containing contraception, and mifepristone for EC are needed to inform WHO recommendations on these methods. As these methods are already being used, international guidance for practitioners is essential.