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 | 18–45 years | Menarche to < 18 years > 45 years | — | — |
Parity | Nulliparous Parous | — | — | — |
Breastfeeding | >= 6 weeks to < 6 months postpartum fully or partially breastfeeding or >= 6 months postpartum | < 6 weeks postpartum | — | — |
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 | Consistently elevated blood pressure: systolic > 140–159 mmHg or diastolic > 90–94 mmHg History of high blood pressure during pregnancy | Adequately controlled hypertension Consistently elevated blood pressure: systolic > 160 or diastolic > 95 mmHg | Vascular disease | — |
Surgery | Major surgery without prolonged immobilization Minor surgery without immobilization History of pelvic surgery | 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 Known thrombogenic mutations, e.g. Factor V Leiden, Prothrombin mutation, Protein S, Protein C, Antithrombin deficiencies Current VTE (on anticoagulants) | — | — |
Raynaud's disease | Primary Raynaud's disease Secondary without lupus anticoagulant | Secondary Raynaud's disease with lupus anticoagulant | — | — |
Systemic lupus erythematosus | | SLE alone Immunosuppressive treatment For continuation With severe thrombocytopenia | Positive (or unknown) antiphospholipid antibodies For initiation With severe thrombocytopenia | |
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 Endometrial cancer Ovarian cancer Uterine fibroids with or without distortion of the uterine cavity | CIN 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) | — | Multiple risk factors for arterial cardiovascular disease Stroke including TIA Current and history of ischaemic heart disease | — |
Gastrointestinal conditions | History of cholestasis: pregnancy-related Inflammatory bowel disease Viral hepatitis: acute or flare, carrier or chronic disease Cirrhosis: mild compensated disease | Gallbladder disease: asymptomatic, symptomatic treated by cholecystectomy, medically 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: vaginitis, current purulent cervicitis or gonorrhoea, chlamydial infection (symptomatic or asymptomatic); or increased risk of STIs High risk of HIV HIV: not using anti-retroviral therapy HIV: using antiretroviral therapy Schistosomiasis Pelvic and non-pelvic tuberculosis Malaria | HIV: using antiretroviral therapy AIDS | — | — |
Diabetes | History of gestational diabetes | 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)† | DMPA with nucleoside reverse transcriptase inhibitors DMPA with non-nucleoside reverse transcriptase inhibitors DMPA with ritonavir-boosted protease inhibitors | NET-EN wit nucleoside reverse transcriptase inhibitors NET-EN with non-nucleoside reverse transcriptase inhibitors NET-EN with ritonavir-boosted protease inhibitors | — | — |
Anticonvulsant therapy drug interactions (and consistent use of condoms is recommended) | DMPA with certain anticonvulsants (phenytoin, carbamazepine, barbiturates, primidone, topiramate, oxcarbazepine) DMPA and NET-EN with lamotrigine | NET-EN with certain anticonvulsants (phenytoin, carbamazepine, barbiturates, primidone, topiramate, oxcarbazepine)† | — | — |
Antimicrobial therapy drug interactions (and consistent use of condoms is recommended) | DMPA and NET-EN with broad spectrum antibiotics, antifungals, antiparasitics. DMPA with rifampicin or rifabutin | NET-EN with rifampicin or rifabutin† | — | — |
BMI = body mass index; CIN = cervical intraepithelial neoplasia; DMPA = depot medroxyprogesterone acetate; hCG = human chorionic gonadotrophin; IDDM = insulin-dependent diabetes; NET-EN = norethisterone acetate; 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 NET-EN is likely to reduce the effectiveness of NET-EN. The effectiveness of DMPA is not likely to be decreased by certain anticonvulsants, rifampicin or rifabutin. |
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