Clinical feature | UKMEC 1 No restrictions | UKMEC 2 Advantages generally outweigh risks | UKMEC 3 Requires expert clinical judgement | UKMEC 4 Contraindicated |
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Age | Menarche to < 40 years | >= 40 years* | — | — |
Parity | Nulliparous Parous | — | — | — |
Breastfeeding | >= 6 months postpartum | Between 6 weeks and 6 months postpartum, and partially breastfeeding (medium to low) | Between 6 weeks and 6 months postpartum, and fully or almost fully breastfeeding | < 6 weeks postpartum |
Postpartum, and not breastfeeding | >= 21 days postpartum | — | < 21 days postpartum | — |
Post-abortion | First- and second-trimester abortion Immediately after septic abortion | — | — | — |
Ectopic pregnancy | History of ectopic pregnancy | — | — | — |
Smoking | — | Age < 35 years Age >= 35 years and stopped smoking >= 1 year ago | Age >= 35 years and smoking < 15 cigarettes per day Age >= 35 years and stopped smoking < 1 year ago | Age >= 35 years and smoking >= 15 cigarettes per day Current and history of ischaemic heart disease Stroke |
Obesity | — | Body mass index (BMI) between 30 and 34 kg/m2 | Body mass index >= 35 kg/m2 | — |
Blood pressure | — | History of high blood pressure during pregnancy | Adequately controlled hypertension Consistently elevated blood pressure: systolic 140–159 mmHg, or diastolic 90–94 mmHg | Systolic blood pressure >= 160 mmHg, or diastolic >= 95 mmHg Vascular disease |
Surgery | History of pelvic surgery Minor surgery without immobilization | Major surgery without prolonged immobilization | — | Major surgery with prolonged immobilization |
Raynaud's disease | Primary Raynaud's disease | Secondary Raynaud's disease (without lupus anticoagulant) | — | Secondary Raynaud's disease (with lupus anticoagulant) |
Systemic lupus erythematosus | — | SLE (alone); with severe thrombocytopaenia; immunosuppressive treatment | — | SLE with positive (or unknown) antiphospholipid antibodies |
Other risk factors for venous thromboembolism (VTE) | Varicose veins | Family history of VTE in a first-degree relative age >= 45 years Superficial thrombophlebitis | Family history of VTE in a first-degree relative age < 45 years Immobility (unrelated to surgery), e.g. wheelchair use, debilitating illness | Current VTE (on anticoagulants) or history of VTE Known thrombogenic mutations, e.g. Factor V Leiden, Prothrombin mutation, Protein S, Protein C, Antithrombin deficiencies |
Headaches | For initiation Non-migrainous headaches (mild or severe) | For initiation Migraine headaches without aura at any age For continuation Non-migrainous headaches (mild or severe) | For continuation Migraine headaches without aura at any age For initiation and continuation History (>=5 years ago) of migraine with aura at any age | For initiation and continuation Migraine headaches with aura at any age |
Epilepsy | Epilepsy and not using a liver enzyme–inducing drug | — | — | — |
Psychological conditions | Depressive disorders | — | — | — |
Breast disease | For initiation and continuation Benign breast disease or a family history of breast cancer | For continuation Undiagnosed mass in breast | For initiation Undiagnosed mass in breast For initiation and continuation History of breast cancer and no evidence of recurrence for 5 years Carriers of known gene mutations associated with breast cancer (e.g. BRCA1) | For initiation and continuation Current breast cancer |
Vaginal bleeding | Irregular pattern (light, or heavy bleeding), but not suspicious Heavy or prolonged bleeding | Unexplained vaginal bleeding (before evaluation) suspicious for serious underlying condition | — | — |
Other gynaecological conditions | Endometriosis Benign ovarian tumour Severe dysmenorrhoea Gestational trophoblastic disease (GTD) when hCG is decreasing or undetectable; or when persistently elevated hCG or malignant disease Cervical ectropion Endometrial or ovarian cancer Uterine fibroids — with or without distortion of the uterine cavity | CIN and cervical cancer | — | — |
Cardiovascular conditions | — | Valvular and congenital heart disease: uncomplicated | Multiple risk factors for arterial cardiovascular disease | Multiple risk factors for arterial cardiovascular disease Valvular and congenital heart disease: complicated (e.g. by pulmonary hypertension, atrial fibrillation, or history of subacute bacterial endocarditis) Current and history of ischaemic heart disease Stroke including TIA |
Gastrointestinal conditions | Viral hepatitis: carrier or chronic Cirrhosis: mild (compensated without complications) For continuation Viral hepatitis: acute or flare | Gallbladder disease: asymptomatic or treated by cholecystectomy History of cholestasis: pregnancy-related Benign liver tumours (focal nodular hyperplasia) Inflammatory bowel disease | Gallbladder disease: symptomatic medically treated or current History of cholestasis: past COC-related For initiation Viral hepatitis: acute or flare (Category given will depend on disease severity) | Cirrhosis: severe (decompensated) Benign liver tumours (hepatocellular adenoma) Malignant liver tumours (hepatoma) For initiation Viral hepatitis: acute or flare (Category given will depend on disease severity) |
Infections | Pelvic inflammatory disease: current or past history of (assuming no risk factors for STIs) STI: current purulent cervicitis, chlamydial infection, or gonorrhoea Vaginitis (including Trichomonas and bacterial vaginosis) Increased risk of STIs HIV: high risk of HIV; current HIV not using antiretroviral therapy; HIV: using antiretroviral therapy Viral hepatitis: carrier Other STIs Schistosomiasis Pelvic and non-pelvic tuberculosis Malaria | HIV: using antiretroviral therapy AIDS | HIV: using antiretroviral therapy | Viral hepatitis: active disease |
Diabetes | History of gestational diabetes | Non-vascular disease: NIDDM and IDDM | Nephropathy, retinopathy, neuropathy Other vascular disease (Category given will depend on disease severity) | Nephropathy, retinopathy, neuropathy Other vascular disease (Category given will depend on disease severity) |
Thyroid | Simple goitre, hypothyroid, hyperthyroid | — | — | — |
Haematological conditions | Anaemias: thalassaemia, iron deficiency | Sickle cell disease | — | — |
Dyslipidaemia | — | Known dyslipidaemia (Category given will depend on disease severity) | Known dyslipidaemia (Category given will depend on disease severity) | — |
Antiretroviral therapy drug interactions (and consistent use of condoms is recommended)† | Nucleoside reverse transcriptase inhibitors | Non-nucleoside reverse transcriptase inhibitors | Ritonavir-boosted protease inhibitors | — |
Anticonvulsant therapy drug interactions (and consistent use of condoms is recommended) | — | — | Certain anticonvulsants† (phenytoin, carbamazepine, barbiturates, primidone, topiramate, oxcarbazepine) Lamotrigine | — |
Antimicrobial therapy drug interactions (and consistent use of condoms is recommended) | Broad spectrum antibiotics† Antifungals Antiparasitics | — | Rifampicin or rifabutin therapy† | — |
* Age >= 40 years: women may use combined oral contraception until age 50 years if there are no medical contraindications. BMI = body mass index; COC = combined oral contraceptive; CIN = cervical intraepithelial neoplasia; hCG = human chorionic gonadotrophin; IDDM = insulin-dependent diabetes mellitus; NIDDM = non–insulin-dependent diabetes mellitus; STI = sexually transmitted infection; SLE = systemic lupus erythematosus; VTE = venous thromboembolism. † The consistent use of condoms is recommended, as antiretroviral drugs may reduce the effectiveness of hormonal contraceptives. Similarly, certain anticonvulsants and lamotrigine, rifampicin and rifabutin therapy can reduce the effectiveness of combined oral contraception. When using these drugs, a COC preparation containing a minimum of 30 micrograms of ethinylestradiol should be used. |
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