Clinical feature | UKMEC 1 No restrictions | UKMEC 2 Advantages generally outweigh risks | UKMEC 3 Requires expert clinical judgement | UKMEC 4 Contraindicated |
|---|
Pregnancy | — | — | — | Pregnancy |
Age | >= 20 years | Menarche to < 20 years | — | — |
Parity | Nulliparous Parous | — | — | — |
Postpartum, breastfeeding or non-breastfeeding, including post-Caesarean Section | >= 4 weeks | — | 48 hours to < 4 weeks | Puerperal sepsis |
Post-abortion | First-trimester abortion | Second-trimester abortion | — | Immediately after septic abortion |
Ectopic pregnancy | History of ectopic pregnancy | — | — | — |
Smoking | Past or current smoker | — | — | — |
Obesity | BMI >= 30 kg/m2 | — | — | — |
Blood pressure | Adequately controlled hypertension Consistently elevated blood pressure systolic >140 mmHg or diastolic >90 mmHg Vascular disease History of high blood pressure during pregnancy | — | — | — |
Surgery | History of pelvic surgery Major surgery with or without prolonged immobilization Minor surgery without immobilization | — | — | — |
Other risk factors for venous thromboembolism | History of VTE Current VTE (on anticoagulants) Family history of VTE in a first-degree relative Immobility (unrelated to surgery), e.g. wheelchair use, debilitating illness Known thrombogenic mutations, e.g. Factor V Leiden, Prothrombin mutation, Protein S, Protein C, Antithrombin deficiencies Varicose veins Superficial thrombophlebitis | — | — | — |
Raynaud's disease | Primary Secondary, with and without lupus anticoagulant | — | — | — |
Systemic lupus erythematosus | SLE alone Positive (or unknown) antiphospholipid antibodies For continuation Immunosuppressive treatment | For initiation Immunosuppressive treatment For continuation Severe thrombocytopenia | For initiation Severe thrombocytopenia | — |
Headaches | Non-migrainous headaches (mild or severe) Migraine headaches with or without aura, at any age History (>= 5 years ago) of migraine with aura, at any age | — | — | — |
Epilepsy | Epilepsy | — | — | — |
Psychological conditions | Depressive disorders | — | — | — |
Breast disease | Undiagnosed mass Benign breast disease or a family history of breast cancer Carriers of known gene mutations associated with breast cancer (e.g. BRCA1) Current breast cancer History of breast cancer and no evidence of recurrence for 5 years | — | — | — |
Vaginal bleeding | Irregular without heavy bleeding | For initiation and continuation Heavy or prolonged bleeding (regular and irregular patterns) For continuation Unexplained vaginal bleeding (before evaluation) suspicious for serious underlying condition | — | For initiation Unexplained vaginal bleeding (before evaluation) suspicious for serious underlying condition |
Other gynaecological conditions | Benign ovarian tumours including cysts Gestational trophoblastic disease when hCG is decreasing or normal Cervical ectropion CIN Uterine fibroids, without distortion of the uterine cavity | For initiation and continuation Severe dysmenorrhoea Endometriosis Other abnormalities (including cervical stenosis or cervical lacerations) not distorting the uterine cavity or interfering with IUD insertion For continuation Cervical cancer, awaiting treatment Endometrial cancer Ovarian cancer | Uterine fibroids, with distortion of the uterine cavity Distorted uterine cavity (any congenital or acquired uterine abnormality distorting the uterine cavity in a manner that is incompatible with IUD insertion) | For initiation and continuation Gestational trophoblastic disease when hCG is persistently elevated or malignant disease For initiation Cervical cancer, awaiting treatment Endometrial cancer Ovarian cancer |
Cardiovascular conditions | Current and history of ischaemic heart disease Stroke including TIA Multiple risk factors for arterial cardiovascular disease Valvular and congenital heart disease: uncomplicated | Valvular and congenital heart disease: complicated (e.g. by pulmonary hypertension, atrial fibrillation, or history of subacute bacterial endocarditis) | — | — |
Gastrointestinal conditions | History of cholestasis (related to pregnancy or combined oral contraceptive) Gallbladder disease: asymptomatic, symptomatic treated by cholecystectomy, medically treated, or current Cirrhosis: mild (compensated) or severe (decompensated) Liver tumours: benign (focal nodular hyperplasia; hepatocellular adenoma) and malignant (hepatoma) Inflammatory bowel disease | — | — | — |
Infections | For initiation and continuation Past pelvic inflammatory disease (with no risk factors for STIs) Schistosomiasis Non-pelvic tuberculosis Malaria Viral hepatitis: acute or flare, carrier or chronic disease | For continuation Current pelvic inflammatory disease Chlamydia (symptomatic and asymptomatic) Current purulent cervicitis or gonorrhoea For initiation and continuation Other STIs (excluding HIV and hepatitis) Vaginitis Increased risk of STIs High risk of HIV HIV (not using antiretroviral therapy) HIV (using antiretroviral therapy) AIDS | HIV (using antiretroviral therapy) For continuation Known pelvic tuberculosis | For initiation Current pelvic inflammatory disease Chlamydia (symptomatic and asymptomatic) Current purulent cervicitis or gonorrhoea Known pelvic tuberculosis |
Diabetes | History of gestational diabetes NIDDM and IDDM, non-vascular disease With nephropathy, retinopathy, or neuropathy; or other vascular disease | — | — | — |
Thyroid | Simple goitre, hypothyroid, hyperthyroid | — | — | — |
Haematological conditions | — | Anaemias: thalassaemia, iron deficiency, or sickle cell disease | — | — |
Dyslipidaemia | Known hyperlipidaemias | — | — | — |
Antiretroviral therapy drug interactions (and consistent use of condoms is recommended)† | | For initiation and continuation‡ Nucleoside reverse transcriptase inhibitors Non-nucleoside reverse transcriptase inhibitors Ritonavir-boosted protease inhibitors | For initiation‡ Nucleoside reverse transcriptase inhibitors Non-nucleoside reverse transcriptase inhibitors Ritonavir-boosted protease inhibitors | — |
Anticonvulsant therapy drug interactions | Certain anticonvulsants (e.g. phenytoin, carbamazepine, barbiturates, primidone, topiramate, oxcarbazepine) Lamotrigine | — | — | — |
Antimicrobial therapy drug interactions | Broad spectrum antibiotics Antifungals Antiparasitics Rifampicin or rifabutin therapy | — | — | — |
BMI = body mass index; CIN = cervical intraepithelial neoplasia; hCG = human chorionic gonadotrophin; IDDM = insulin-dependent diabetes; IUD = intrauterine device; NIDDM = non-insulin-dependent diabetes; STI = sexually transmitted infection; SLE = systemic lupus erythematosus; TIA = transient ischaemic attack; VTE = venous thromboembolism. † The consistent use of condoms is recommended for women with HIV or AIDs on antiretroviral therapy, to prevent HIV transmission. ‡ There is no known interaction between antiretroviral therapy and IUD use. However, AIDS is classified as Category 3 for insertion and Category 2 for continuation unless the woman is clinically well on antiretroviral therapy, in which case both insertion and continuation are classified as Category 2. |
|