To assess a woman's eligibility for use of a combined oral contraceptive (COC):

• In young women and women with special needs, assess their competence to decide, and support them in making their own decisions about contraception.
• Exclude pregnancy.
• Assess the woman's risk for sexually transmitted infection and, when appropriate, advise testing, promote safer sex, and/or refer for counselling.
• Check the woman's blood pressure, weight and body mass index.
• Check the criteria in Combined hormonal methods to ensure that the assessment is complete and that the woman is eligible for a COC.
• Women should not use a COC (UKMEC 4) in the following situations:
• Breastfeeding and less than 6 weeks postpartum.
• Age 35 years or more and smoking 15 or more cigarettes daily.
• Multiple risk factors for arterial cardiovascular disease (e.g. older age, smoking, diabetes, and hypertension) — UKMEC 3 if less severe (see below).
• Hypertension not adequately controlled (systolic blood pressure equal to, or greater than 160 mmHg, OR diastolic blood pressure equal to, or greater than 95 mmHg).
• Vascular disease, including angina or other ischaemic heart disease, intermittent claudication, hypertensive retinopathy, transient ischaemic attacks, or other cerebrovascular disease.
• Venous thromboembolism (history, or currently receiving treatment).
• High risk of venous thromboembolism (e.g. major surgery with prolonged immobilization, known thrombogenic mutation, Raynaud's disease with lupus anticoagulant).
• Valvular or congenital heart disease if complicated by pulmonary hypertension, atrial fibrillation, or subacute bacterial endocarditis.
• Migraine with aura (any age).
• Current breast cancer.
• Diabetes with nephropathy, neuropathy, retinopathy, or other vascular disease — UKMEC 3 if less severe.
• Cirrhosis of the liver, decompensated (e.g. ascites, jaundice, encephalopathy, or gastrointestinal haemorrhage).
• Liver tumours — benign (hepatocellular adenoma) or malignant (hepatoma).
• Women should use a COC only after consultation with an expert (UKMEC 3) in the following situations:
• Breastfeeding and between 6 weeks and 6 months postpartum.
• Less than 21 days postpartum and not breastfeeding.
• Age 35 or more years and either smoking less than 15 cigarettes daily, or stopped smoking less than 1 year ago.
• BMI greater than 35 kg/m².
• Multiple risk factors for arterial cardiovascular disease (such as older age, smoking, diabetes, and hypertension) — UKMEC 4 if more severe.
• Hypertension adequately controlled (systolic blood pressure less than 159 mmHg, AND diastolic blood pressure less than 94 mmHg).
• Family history of venous thromboembolism in a first-degree relative less than 45 years of age.
• Moderately increased risk of venous thromboembolism (e.g. immobility unrelated to surgery, wheelchair use, debilitating illness).
• Known dyslipidaemia with increased risk of cardiovascular disease.
• Migraine without aura at any age, while already using the COC pill, patch, or ring.
• History of migraine (at least 5 years ago) with aura, at any age.
• Undiagnosed breast mass, carriers of known gene mutations associated with breast cancer (e.g. BRCA1), past history of breast cancer with no recurrence for 5 or more years.
• Diabetes with nephropathy, neuropathy, retinopathy, or other vascular disease — UKMEC 4 if more severe.
• Gall bladder disease, current or medically treated.
• History of cholestasis related to past COC use.
• Use of liver enzyme–inducing drugs (see Selected concurrent medications).

• The following examinations and laboratory tests are not required to assess eligibility for a combined oral contraceptive (COC):
• Breast, pelvic, or genital examination
• Cervical cytology screening
• Routine laboratory tests, including haemoglobin measurement
• Thrombophilia screening

• These recommendations are based on the guidelines for First prescription of combined oral contraception and the UK medical eligibility criteria for contraceptive use issued by the Faculty of Faculty of Sexual and Reproductive Health Care [FFPRHC, 2007b; FSRH, 2009b].
• The examinations and investigations that are specifically not recommended do not contribute substantially to combined oral contraceptive safety [British Society for Haematology, 2001; FFPRHC, 2007b].