UK Medical Eligibility Criteria (UKMEC) for combined oral contraceptive use
Combined oral contraceptive: Issues for current users articleIssue 12 Contents
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| UKMEC Category 1 – Unrestricted Use | |
| Age – menarche to <40 years Parity – nulliparous and parous Breastfeeding – >6 months postpartum Postpartum – >21 days if not breastfeeding Post-abortion – immediately first and second trimester, and post-septic Past ectopic pregnancy History of pelvic surgery Minor surgery without immobilisation Varicose veins Non-migrainous headaches – mild or severe Epilepsy – and not using liver enzyme-inducers Depressive disorders Vaginal bleeding – unsuspicious irregular, heavy or prolonged Endometriosis Benign ovarian tumour Severe dysmenorrhoea Gestational trophoblastic neoplasia – when hCG is normal |
Cervical ectropion Breast disease – benign breast disease or a family history of breast cancer Endometrial or ovarian cancer Uterine fibroids – with or without distortion of the uterine cavity PID – current; or past history of, with or without subsequent pregnancy STI – current, vaginitis or increased risk of STI HIV/AIDS – risk of HIV/AIDS, current HIV not using antiretroviral therapy Schistosomiasis, pelvic and non-pelvic tuberculosis, malaria Diabetes – history of gestational disease Thyroid disorders Viral hepatitis – carrier Anaemias – thalassaemia, iron deficiency Raynaud’s disease – primary without lupus anticoagulant |
| UKMEC Category 2 – Benefits generally outweigh risks | |
| Age – ≥40 yearsa Breastfeeding – between 6 weeks and 6 months postpartum and partially breastfeeding (medium to low) Smoking – aged <35 years, or aged ≥35 years and stopped smoking ≥1 year ago Obesity – BMI ≥30–34 kg/m2 History of high blood pressure during pregnancy Family history of VTE in a first-degree relative aged ≥45 years Major surgery without prolonged immobilisation Superficial thrombophlebitis Known hyperlipidaemias – e.g. common hypercholesterolaemia or familial combined hyperlipidaemia Valvular and congenital heart disease – uncomplicated Migraine headaches – without aura in women aged <35 years |
Vaginal bleeding – suspicious for serious condition before
evaluation CIN and cervical cancer HIV/AIDS – current HIV using antiretroviral therapy, or current AIDS and using HAART Diabetes – NIDDM and IDDM, non-vascular disease Gallbladder disease – asymptomatic or treated with a cholecystectomy History of cholestasis – pregnancy-related Inflammatory bowel disease Sickle cell disease Raynaud’s disease – secondary without lupus anticoagulant Non-liver enzyme-inducing antibiotics Highly active antiretroviral therapy (HAART) |
| UKMEC Category 3 – Risks generally outweigh benefitsb | |
| Breastfeeding – between 6 weeks and 6 months postpartum
and fully or almost fully breastfeeding Postpartum – <21 days postpartum Smoking – aged ≥35 years and smoking <15 cigarettes per day, or stopped smoking <1 year ago Obesity – BMI 35–39 kg/m2 Cardiovascular disease – multiple risk factors for arterial cardiovascular disease Hypertension – elevated blood pressure >140 to 159 mmHg systolic or >90 to 94mmHg diastolic Family history of VTE in a first-degree relative aged <45 years Immobility (unrelated to surgery) – e.g. wheelchair use, debilitating illness Known hyperlipidaemias – e.g. familial hypercholesterolaemia |
Migraine headaches – without aura in women aged ≥35
years; or a past history of migraine with aura at any age Breast disease – past history of breast cancer and no evidence of recurrence for 5 years; carriers of known gene mutations associated with breast cancer (e.g. BRCA1); undiagnosed mass Diabetes – with nephropathy/ retinopathy/ neuropathy; or other vascular disease or diabetes of >20 years’ duration (category given will depend on disease severity) Gallbladder disease – symptomatic medically treated or current History of cholestasis – past COC-related Cirrhosis – mild compensated disease Drugs which induce liver enzymes – e.g. rifampicin, rifabutin, St John’s Wort, griseofulvin and certain anticonvulsants (i.e. phenytoin, carbamazepine, barbiturates, primidone, topiramate, oxcarbazepine) |
| UKMEC Category 4 – Unacceptable health risk and should not be used | |
| Breastfeeding – <6 weeks postpartum Smoking – aged ≥35 years and smoking ≥15 cigarettes per day Obesity – BMI ≥40 kg/m2 Cardiovascular disease – multiple risk factors for arterial cardiovascular disease Hypertension – blood pressure ≥160 mmHg systolic and/ or ≥95 mmHg diastolic; or vascular disease VTE – current (on anticoagulants) or past history Major surgery with prolonged immobilisation Known thrombogenic mutations Current and history of ischaemic heart disease Stroke |
Valvular and congenital heart disease – complicated by
pulmonary hypertension, atrial fibrillation, history of subacute
bacterial endocarditis Migraine headaches – with aura at any age Gestational trophoblastic neoplasia – when hCG is abnormal Breast disease – current breast cancer Diabetes – with nephropathy, retinopathy, neuropathy or other vascular disease, or diabetes of >20 years’ duration (category given will depend on disease severity) Viral hepatitis – active disease Cirrhosis – severe decompensated disease Liver tumours – benign and malignant Raynaud’s disease – secondary with lupus anticoagulant and thus a tendency to thrombosis |
| a Age ≥40 years: women may use COC until age 50 years if there are no medical contraindications. b Definition of UKMEC 3 – the risks generally outweigh the benefits but the method can be considered for use with clinical judgement and/ or specialist referral if other methods are unacceptable. AIDS, acquired immune deficiency syndrome; BMI, body mass index; CIN, cervical intraepithelial neoplasia; HAART, highly active antiretroviral therapy; hCG, human chorionic gonadotrophin; HIV, human immunodeficiency virus; IDDM, insulin-dependent diabetes; NIDDM, non-insulin-dependent diabetes; PID, pelvic inflammatory disease; STI, sexually transmitted infection; TB, tuberculosis; VTE, venous thromboembolism. |
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Reference
Faculty of Sexual and Reproductive Health Care Clinical Effectiveness Unit. First prescription of combined oral contraceptive. Available from: www.fsrh.org. Accessed February 2008
