Condition
Nulliparous
<20Y
>20Y
0 48hrs post partum
48hrs 4w post partum
>= 4w post partum
Current breast cancer
Breast cancer <5yrs ago
Uterine fibroids not distorting
cavity
Uterine fibroids distorting cavity
Known long QT syndrome
Condition
Aged <18 or >45y
Multiple risk factors for
vascular disease
Complicated diabetes mellitus
(neuropathy/nephropathy/retin
opathy/vascular disease)
SLE with positive or unknown
anti-phospholipid antibodies
Development of IHD or CVA on
method
History of bariatric surgery (any
BMI)
Current breast cancer
<6w post-partum
Condition
BMI<30
BMI 30 35
BMI >35
Migraine with aura
(Note: an additional resource at the
end of the UKMEC 2016 gives more
information on
migraine diagnosis)
Uncomplicated diabetes mellitus
Breast-feeding <6w post-partum
Breast-feeding 6w to <6m
Cu-IUD LNG-IUS Comments
1 1 IUDs can be fitted in women regardless of age and parity.
2 2 Careful counselling regarding the insertion procedure should
1 1 be performed.
1 1 4w is quoted by the UKMEC because of risk of perforation
3 3 before then. Most practitioners would leave it longer (usually
1 1 up to 3m) to reduce this risk further.
1 4 Breast cancer may be hormonally
1 3 sensitive.
1 1 There is some evidence that IUS can
reduce size and symptoms of fibroids.
3 3 Even with some distortion it may be
appropriate to attempt an IUS fitting.
3 3 Insertion only. Cervical stimulation during intrauterine device
insertion can induce a vasovagal reaction. Bradycardia can
increase the risk of a cardiac event in women with long QT
syndrome. The device should be fitted in a hospital setting if
vasovagal reaction presents a particularly high risk of cardiac
events.
POI POP SDI Comments
2 1 1 Evidence of long-term effect of POI on bone mineral
density loss in those <18 is lacking. Data suggest that
there is a small reduction in BMD in POI users but
this reverses after cessation of the method. POI
users should be reviewed every 2y to discuss
ongoing risks and benefits. POI should be stopped at
age 50y.
3 2 2 There are concerns about the hypo-oestrogenic
effects and reduced HDL levels from POI. This effect
is absent with POPs and SDIs.
2 2 2
2 2 2
3 3 3
1 1 1 Surgery which potentially induces a malabsorptive
state has the potential to reduce oral contraceptive
efficacy, especially if accompanied by vomiting or
diarrhoea. However, limited evidence suggests that
gastric bypass and banding do not appear to reduce
contraceptive efficacy.
4 4 4
2 1 1 There is no evidence that POC affects breast milk or
infant growth. FSRH state can usebefore 6w but
ideally delay until day 21.
CHC Comments
1 Risk of VTE increases with BMI. There is no upper limit to BMI in terms of UKMEC so
2 morbid obesity is not an absolute contraindication to CHC unless accompanied by
3 other risk factors. A history of bariatric surgery does not change these categories.
4 Migraine with aura sufferers have 24 times the risk of CVA compared with
those not using the COC. An aura:
occurs before the onset of headache
lasts 560min
can be a homonymous hemianopia, unilateral paraesthesia or weakness,
dysphasia
visual aura can be fortification spectra (a star-shaped figure near thepoint of
fixation with scintillating edges) or scotoma (a bright shape which gradually
increases in size).
2 Only diabetes complicated by vascular disease or
nephropathy/neuropathy/retinopathy becomes a UKMEC 3.
4 <21d post-natal there are concerns regarding risk of VTE with CHC due to residual
2 pro-thrombotic state of pregnancy. Also use of CHC up to 6w postpartum
Breast-feeding >6m post-partum
Post-natal (not breast-feeding) <3w
Post-natal (not breast-feeding) 3 6w
Post-natal (not breast-feeding) >6w
Smoker >15 cigarettes/day and >35y
Ex-smoker stopped <1y ago and >35y
BP >140/90
BP >160/95
Adequately controlled hypertension
History of high BP during pregnancy
Multiple risk factors for CVD
Cardiomyopathy: Normal cardiac
function
Cardiomyopathy: Abnormal cardiac
function
SLE with positive or unknown
antiphospholipid antibodies
FH breast cancer
Carriers of genetic mutations giving rise
to increased risk of breast cancer
(BRCA1)
Current symptomatic gall-bladder
disease
Asymptomatic gall-bladder disease or
treated by cholecystectomy
Major surgery with prolonged
immobilisation
Major surgery without prolonged
immobilisation
Minor surgery without prolonged
immobilisation
Immobility (e.g. wheelchair user)
1 has been found to reduce milk volumes. After 6w there is no evidence of a
detrimental effect on infant growth.
3 If other risk factors for VTE are present, categories are same +1. 3 becomes 4 etc.
2
1
4 CHC users who smoke have higher rates of CVD. Risk of MI is highest in those who
3 smoked >15/day. 35y is used as it is the age from which excess mortality from
smoking is apparent. Risk from smoking gradually declines after stopping and within
15 years the risk of CVD has returned to baseline.
3 CHC users with hypertension have an increased risk of vascular disease.
4 Although treated hypertension should reduce this risk, there is no evidence to
3 support this, so the British Hypertension Society recommends that alternative
2 contraceptive methods may be more suitable.
3
2
4
4 SLE increases the risk of ischaemic and thrombotic vascular disease.
1 Among COC users with a FH of breast cancer the risks of breast cancer
3 are the same as non-COC users with a FH of breast cancer. This is not the
case for carriers of BCRA1 where there may exist an increased risk.
3 CHCs may increase the risk of developing gall-bladder disease and may
worsen existing gall-bladder disease.
2
4 Major surgery is >30min operation. Neurosurgical, orthopaedic, trauma
and general surgical procedures carry an increased risk of VTE. CHC
2 should be stopped 4w prior to planned surgery.
1
3