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 > 45 years | — | — | — |
Parity | Nulliparous Parous | — | — | — |
Breastfeeding | < 6 weeks postpartum or >= 6 weeks to < 6 months postpartum fully or partially (medium to low) breastfeeding or >= 6 months 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 | Body mass index >= 30 kg/m2 | — | — | — |
Blood pressure | Adequately controlled hypertension Consistently elevated blood pressure: systolic > 140–159 mmHg or diastolic > 90–94 mmHg Systolic > 160 or diastolic > 95 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 or 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 with and without lupus anticoagulant | — | — |
Systemic lupus erythematosus | — | SLE alone; with severe thrombocytopaenia; immunosuppressive treatment | SLE with positive (or unknown) antiphospholipid antibodies | — |
Headaches | For initiation and continuation Non-migrainous headaches (mild or severe) For initiation Migraine headaches without aura (any age) | For continuation Migraine headaches without aura, any age For initiation and continuation Migraine headaches with aura, any age Past history (>= 5 years ago) of migraine with aura, any age | — | — |
Epilepsy | Epilepsy and not using liver enzyme–inducing drugs | — | — | — |
Psychological conditions | Depressive disorders | — | — | — |
Breast disease | Benign breast disease or 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 |
Unexplained 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 (GTD) when hCG is decreasing or undetectable; when hCG is persistently elevated or malignant disease Cervical ectropion CIN Cervical cancer (awaiting treatment) Endometrial or ovarian cancer Uterine fibroids with or without distortion of the uterine cavity | — | — | — |
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 Current and history of ischaemic heart disease Multiple risk factors for arterial cardiovascular disease | For continuation Stroke Current and history of ischaemic heart disease | — |
Gastrointestinal conditions | History of cholestasis related to pregnancy Viral hepatitis: acute or flare; carrier; or chronic Cirrhosis: mild (compensated) | Gallbladder disease: asymptomatic, symptomatic treated by cholecystectomy, medically treated or current History of cholestasis related to combined oral contraception Liver tumours: benign (focal nodular hyperplasia) Inflammatory bowel disease | Cirrhosis: severe (decompensated) Liver tumours: benign (hepatocellular adenoma) and malignant (hepatoma) | — |
Infections | Pelvic inflammatory disease: current or past history of (assuming no risk factors for STIs) STI: vaginitis, current purulent cervicitis, chlamydial infection, gonorrhoea; or increased risk of STI HIV: high risk of HIV; current HIV not using antiretroviral therapy HIV: using antiretroviral therapy Schistosomiasis Pelvic and non-pelvic tuberculosis Malaria | HIV: using antiretroviral therapy AIDS | HIV: using antiretroviral therapy | — |
Diabetes | History of gestational diabetes | NIDDM and IDDM, non-vascular disease With nephropathy, retinopathy or neuropathy; Other vascular disease | — | — |
Thyroid | Simple goitre, hypothyroid, hyperthyroid | — | — | — |
Haematological conditions | Anaemias: thalassaemia, iron deficiency, sickle cell disease | — | — | — |
Dyslipidaemia | — | Known dyslipidaemias | — | — |
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 (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; 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, and POPs is likely to reduce the effectiveness of POPs. |
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