Clinical feature | UKMEC 1 No restrictions | UKMEC 2 Advantages generally outweigh risks | UKMEC 3 Requires expert clinical judgement | UKMEC 4 Contraindicated |
|---|
Age | Menarche to menopause | — | — | — |
Parity | Nulliparous Parous | — | — | — |
Breastfeeding | At any time | — | — | — |
Postpartum, not breastfeeding | At any time (although contraception is not necessary until 21 days after delivery) | — | — | — |
Post-abortion | First- and 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 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 SLE with severe thrombocytopenia Immunosuppressive treatment | Positive (or unknown) antiphospholipid antibodies | — |
Headaches | For initiation and continuation Non-migrainous headaches (mild or severe) | For initiation and continuation Migraine headaches without aura (any age) Migraine headaches with aura (any age) Past history (>= 5 years ago) of migraine with aura (any age) | — | — |
Epilepsy | Epilepsy | — | — | — |
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 | — | 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 tumours including cysts Severe dysmenorrhoea Gestational trophoblastic disease when hCG is normal, persistently elevated, or malignant disease Cervical ectropion CIN Endometrial cancer Ovarian cancer Uterine fibroids with or without distortion of the uterine cavity | Cervical cancer (awaiting treatment) | — | — |
Cardiovascular conditions | 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) | For initiation Stroke including TIA Current and history of ischaemic heart disease For initiation and continuation Multiple risk factors for arterial cardiovascular disease | For continuation Stroke including TIA Current and history of ischaemic heart disease | — |
Gastrointestinal conditions | History of cholestasis: pregnancy-related Inflammatory bowel disease Cirrhosis: mild compensated disease Viral hepatitis: acute or flare, carrier, or chronic disease | Gallbladder disease: asymptomatic, or treated, or current History of cholestasis: related to combined oral contraceptive Liver tumours: benign (focal nodular hyperplasia) | Cirrhosis: severe decompensated disease Liver tumours: benign (hepatocellular adenoma) and malignant (hepatoma) | — |
Infections | Pelvic inflammatory disease: current or past (assuming no risk factors for STIs) STIs: chlamydia infection (symptomatic or asymptomatic) STIs: current purulent cervicitis or gonorrhoea, vaginitis, or increased risk of STIs HIV/AIDS: high risk of HIV HIV: current infection not using antiretroviral therapy HIV: current infection using antiretroviral therapy Schistosomiasis Pelvic and non-pelvic tuberculosis Malaria | HIV: current infection using antiretroviral therapy AIDS | — | — |
Diabetes | History of gestational diabetes | NIDDM and IDDM, non-vascular disease Diabetes 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)† | Nucleoside reverse transcriptase inhibitors | Non-nucleoside reverse transcriptase inhibitors Ritonavir-boosted protease inhibitors | — | — |
Anticonvulsant therapy drug interactions (and consistent use of condoms is recommended) | Lamotrigine | Certain anticonvulsants (phenytoin, carbamazepine, barbiturates, primidone, topiramate, oxcarbazepine)† | — | — |
Antimicrobial therapy drug interactions (and consistent use of condoms is recommended) | 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; 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, as antiretroviral drugs may reduce the effectiveness of hormonal contraceptives. Similarly, the interaction of certain anticonvulsants, rifampicin or rifabutin, with implants is likely to reduce the effectiveness of implants. |