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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Pregnancy | — | — | — | Pregnancy |
Age | >= 20 years | Menarche to < 20 years | — | — |
Parity | Nulliparous Parous | — | — | — |
Postpartum, breastfeeding or non-breastfeeding; and 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 | Current or previous smoker | — | — | — |
Obesity | BMI >= 30kg/m2 | — | — | — |
Blood pressure | Adequately controlled hypertension Consistently elevated blood pressure systolic >140 mmHg or diastolic >90 mmHg History of high blood pressure during pregnancy | Vascular disease | — | — |
Surgery | History of pelvic surgery Major surgery without prolonged immobilization Minor surgery without immobilization | Major surgery with prolonged immobilization | — | — |
Other risk factors for venous thromboembolism | Family history of VTE in a first degree relative Immobility (unrelated to surgery), e.g. wheelchair use, debilitating illness Varicose veins Superficial thrombophlebitis | History of VTE Current VTE (on anticoagulants) Known thrombogenic mutations, e.g. Factor V Leiden, Prothrombin mutation, Protein S, Protein C, Antithrombin deficiencies | — | — |
Raynaud's disease | Primary Secondary without lupus anticoagulant | Secondary with lupus anticoagulant | — | — |
Systemic lupus erythematosus | — | SLE alone Severe thrombocytopenia Immunosuppressive treatment | Positive (or unknown) antiphospholipid antibodies | — |
Headaches | Non-migrainous headaches (mild or severe) | Migraine without aura (any age) Migraine with aura (any age) Past history (>= 5 years) of migraine with aura (any age) | — | — |
Epilepsy | Epilepsy (see drug interactions section) | — | — | — |
Psychological conditions | Depressive disorders | — | — | — |
Breast disease | Benign breast disease or a family history of breast cancer | Undiagnosed mass Carriers of known gene mutations associated with breast cancer (e.g. BRCA1) | History of breast cancer and no evidence of recurrence for 5 years | Current breast cancer |
Vaginal bleeding | Initiation and continuation Irregular without heavy bleeding Initiation Heavy or prolonged bleeding (regular and irregular patterns) | Continuation Vaginal bleeding, suspicion for serious condition Heavy or prolonged bleeding (regular and irregular patterns) | — | Initiation Unexplained vaginal bleeding (before evaluation) suspicious for serious underlying condition |
Other gynaecological conditions | Initiation and continuation Benign ovarian tumours, including cysts Cervical ectropion Uterine fibroids without distortion of the uterine cavity Endometriosis Severe dysmenorrhoea Gestational trophoblastic disease when hCG is normal or decreasing | Continuation Cervical cancer, awaiting treatment Endometrial cancer Ovarian cancer Initiation and continuation Other abnormalities (including cervical stenosis or cervical lacerations) not distorting the uterine cavity or interfering with IUS insertion CIN | 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 IUS insertion) | Initiation Cervical cancer, awaiting treatment Endometrial cancer Ovarian cancer Initiation and continuation Gestational trophoblastic disease when hCG is persistently elevated or malignant disease |
Cardiovascular conditions | Valvular and congenital heart disease: uncomplicated | Initiation Current and history of ischaemic heart disease Stroke including TIA Initiation and continuation 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) | Continuation Current and history of ischaemic heart disease Stroke including TIA | — |
Gastrointestinal conditions | History of cholestasis: pregnancy related Cirrhosis, mild (compensated) Inflammatory bowel disease | Gallbladder disease: asymptomatic, symptomatic treated by cholecystectomy, medically treated, or current History of cholestasis: combined oral contraceptive related Liver tumours: benign (focal nodular hyperplasia) | Cirrhosis, severe (decompensated) Liver tumours: benign (hepatocellular adenoma) Liver tumours: malignant (hepatoma) | — |
Infections | For initiation and continuation Past pelvic inflammatory disease (assuming no current risk factors for STIs) Schistosomiasis Non-pelvic tuberculosis Malaria Viral hepatitis: acute or flare, carrier or chronic | 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 For continuation Current pelvic inflammatory disease Chlamydia (symptomatic or asymptomatic) Current purulent cervicitis or gonorrhoea | For initiation and continuation HIV, using antiretroviral therapy For continuation Known pelvic tuberculosis | For initiation Current pelvic inflammatory disease Chlamydia (symptomatic or asymptomatic) Current purulent cervicitis or gonorrhoea Known pelvic tuberculosis |
Diabetes | History of gestational diabetes | NIDDM and IDDM, non-vascular disease With nephropathy, retinopathy, neuropathy; or other vascular disease | — | — |
Thyroid | Simple goitre, hypothyroid, hyperthyroid | — | — | — |
Haematological conditions | Anaemias: thalassaemia, iron deficiency, 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 (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. ‡ 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. |
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