Overview
This Guidelines summary covers the key conditions that women commonly present with in a primary care setting. Please refer to the full guideline for evidence, clarifications, and additional comments associated with the recommendations.
Aims of the UKMEC Guideline
- The UK Medical Eligibility Criteria for Contraceptive Use (UKMEC) offers guidance to providers of contraception regarding who can use contraceptive methods safely, including by individuals with certain health conditions (for example hypertension) or characteristics (for example age) to prevent an unintended pregnancy
- These evidence-based recommendations do not indicate a best method for a woman nor do they take into account efficacy—and this includes drug interactions or malabsorption
- The guidance does not indicate a best method for a woman nor do they take into account efficacy (and this includes drug interactions or malabsorption).
Using the UKMEC Tables
Condition
- The first column indicates the condition. Each condition is defined as representing either an individual’s characteristics (for example age, parity) or a known pre-existing medical condition (for example diabetes, hypertension). Some conditions are subdivided to differentiate between varying degrees of the condition (for example migraine with or without aura).
Methods of Contraception
- The tables in this Guidelines summary considers the following methods of contraception:
- copper-bearing intrauterine device (Cu-IUD)
- levonorgestrel-releasing intrauterine system (LNG-IUS)
- progestogen-only:
- implant (IMP)
- injectable (DMPA)
- pill (POP)
- combined hormonal contraception (CHC)
- Please refer to the full guideline for the UKMEC table for emergency contraception
- Please note that the contraceptive methods are now reordered (from left to right) in the tables to broadly reflect long-acting/more effective to shorter acting/less effective methods. This is a key change from the previous edition of the UKMEC guidance.
Categories
| UKMEC | DEFINITION OF CATEGORY |
|---|---|
| Category 1 | A condition for which there is no restriction for the use of the method |
| Category 2 | A condition where the advantages of using the method generally outweigh the theoretical or proven risks |
| Category 3 | A condition where the theoretical or proven risks usually outweigh the advantages of using the method. The provision of a method requires expert clinical judgement and/or referral to a specialist contraceptive provider, since use of the method is not usually recommended unless other more appropriate methods are not available or not acceptable |
| Category 4 | A condition which represents an unacceptable health risk if the method is used |
- The category (UKMEC1 to UKMEC4) for each condition is given for each method of contraception. Occasionally, NA (not applicable) is used, which denotes a condition for when a ranking was not given but clarifications have been provided in the full guideline
- The definitions of the categories are given in the tables in this Guidelines summary
- If a contraception is used for a non-contraceptive indication (for example management of heavy menstrual bleeding) the risk/benefit profile and eligibility criteria may differ
- Categories cannot be added together to indicate the safety of using a method. For example, if a woman has two conditions that are each UKMEC2 for use of CHC, these should not be added to make a UKMEC4. However, if multiple UKMEC2 conditions are present that all relate to the same risk, clinical judgement must be used to decide whether the risks of using the method may outweigh the benefits. For example, consider a 34-year-old woman wishing to use combined hormonal contraception (CHC) who has a body mass index (BMI) of 34 kg/m2 (UKMEC2), is a current smoker (UKMEC2), has a history of superficial venous thrombosis (UKMEC2), and has a first-degree relative who had a venous thromboembolic event at age 50 years (UKMEC2), all potential risk factors for venous thromboembolism (VTE). She might be better advised to consider a different method of contraception that does not increase her risk of VTE
- When an individual has multiple conditions all scoring UKMEC3 for a method, use of this method may pose an unacceptable risk; clinical judgement should be used in each individual case.
Initiation and Continuation of a Method
- The initiation (I) and continuation (C) of a method of contraception can sometimes be distinguished and classified differently (see tables in this Guidelines summary). The duration of use of a method of contraception prior to the new onset of a medical condition may influence decisions regarding continued use. However, there is no set duration and clinical judgement will be required.
Drug Interactions with Hormonal Contraception
- Drug interactions can potentially cause adverse effects. Health professionals providing hormonal contraception should ask women about their current and previous drug use including prescription, over-the-counter, herbal, recreational drugs, and dietary supplements. Women should be advised to use the most effective methods for them; this may include the additional use of non-hormonal barrier methods when potential drug interactions pose concern
- For further information on drug interactions, please refer to:
- FSRH guidance on drug interactions with hormonal contraception www.fsrh.org/home
- the British National Formulary www.bnf.org
- summary of product characteristics www.medicines.org.uk/emc.
Personal Characteristics and Reproductive History
| CONDITION | Cu-IUD | LNG-IUS | IMP | DMPA | POP | CHC |
|---|---|---|---|---|---|---|
| PERSONAL CHARACTERISTICS AND REPRODUCTIVE HISTORY | ||||||
| Pregnancy | NA | NA | NA | NA | NA | NA |
| Age | Menarche to <20=2,≥20=1 | Menarche to <20=2, ≥20=1 | After menarche=1 | Menarche to <18=2, 18-45=1, >45=2 | After menarche=1 | Menarche to <40=1, ≥40=2 |
| Parity | ||||||
| (a) Nulliparous | 1 | 1 | 1 | 1 | 1 | 1 |
| (b) Parous | 1 | 1 | 1 | 1 | 1 | 1 |
| Breastfeeding | ||||||
| (a) 0 to <6 weeks postpartum | See below | 1 | 2 | 1 | 4 | |
| (b) ≥6 weeks to <6 months (primarily breastfeeding) | 1 | 1 | 1 | 2 | ||
| (c) ≥6 months | 1 | 1 | 1 | 1 | ||
| Postpartum (in non-breastfeeding women) | ||||||
| (a) 0 to <3 weeks | ||||||
| (i) With other risk factors for VTE | See below | 1 | 2 | 1 | 4 | |
| (ii) Without other risk factors | 1 | 2 | 1 | 3 | ||
| (b) 3 to <6 weeks | ||||||
| (i) With other risk factors for VTE | See below | 1 | 2 | 1 | 3 | |
| (ii) Without other risk factors | 1 | 1 | 1 | 2 | ||
| (c) ≥6 weeks | 1 | 1 | 1 | 1 | ||
| Postpartum (in breastfeeding or non-breastfeeding women, including post caesarean section) | ||||||
| (a) 0 to <48 hours | 1 | 1 | See above | |||
| (a) 0 to <48 hours | 3 | 3 | ||||
| (c) ≥4 weeks | 1 | 1 | ||||
| (d) Postpartum sepsis | 4 | 4 | ||||
| Post-abortion | ||||||
| (a) First trimester | 1 | 1 | 1 | 1 | 1 | 1 |
| (b) Second trimester | 2 | 2 | 1 | 1 | 1 | 1 |
| (c) Post-abortion sepsis | 4 | 4 | 1 | 1 | 1 | 1 |
| Past ectopic pregnancy | 1 | 1 | 1 | 1 | 1 | 1 |
| History of pelvic surgery (including caesarean section) | 1 | 1 | 1 | 1 | 1 | 1 |
| Smoking | ||||||
| (a) Age <35 years | 1 | 1 | 1 | 1 | 1 | 2 |
| (b) Age ≥35 years | ||||||
| (i) <15 cigarettes/day | 1 | 1 | 1 | 1 | 1 | 3 |
| (ii) ≥154 cigarettes/day | 1 | 1 | 1 | 1 | 1 | 4 |
| (iii) Stopped smoking <1 year | 1 | 1 | 1 | 1 | 1 | 3 |
| (iv) Stopped smoking ≥1 year | 1 | 1 | 1 | 1 | 1 | 2 |
| Obesity | ||||||
| (a) BMI ≥30–34 kg/m2 | 1 | 1 | 1 | 1 | 1 | 2 |
| (b) BMI ≥35 kg/m2 | 1 | 1 | 1 | 1 | 1 | 3 |
| History of bariatric surgery | ||||||
| (a) With BMI <30 kg/m2 | 1 | 1 | 1 | 1 | 1 | 1 |
| (b) With BMI ≥30–34 kg/m2 | 1 | 1 | 1 | 1 | 1 | 2 |
| (c) With BMI ≥35 kg/m2 | 1 | 1 | 1 | 1 | 1 | 3 |
| Please refer to the full guideline for recommendations on organ transplant | ||||||
| BMI=body mass index; NA=not applicable; VTE=venous thromboembolism. | ||||||
Cardiovascular Disease
| CONDITION | Cu-IUD | LNG-IUS | IMP | DMPA | POP | CHC | ||||
|---|---|---|---|---|---|---|---|---|---|---|
| CARDIOVASCULAR DISEASE | ||||||||||
| Multiple risk factors for CVD (such as smoking, diabetes, hypertension, obesity and dyslipidaemias) | 1 | 2 | 2 | 3 | 2 | 3 | ||||
| Cardiac arrhythmias | ||||||||||
| (a) Atrial fibrillation | 1 | 2 | 2 | 2 | 2 | 4 | ||||
| (b) Known long QT syndrome | I | C | I | C | 1 | 2 | 1 | 2 | ||
| 3 | 1 | 3 | 1 | |||||||
| Hypertension | ||||||||||
| (a) Adequately controlled hypertension | 1 | 1 | 1 | 2 | 1 | 3 | ||||
| (b) Consistently elevated BP levels (properly taken measurements) | ||||||||||
| (i) Systolic >140–159 mmHg or diastolic >90–99 mmHg | 1 | 1 | 1 | 1 | 1 | 3 | ||||
| (ii) Systolic ≥160 mmHg or diastolic ≥ 100 mmHg | 1 | 1 | 1 | 2 | 1 | 4 | ||||
| (c) Vascular disease | 1 | 2 | 2 | 3 | 2 | 4 | ||||
| History of high BP during pregnancy | 1 | 1 | 1 | 1 | 1 | 2 | ||||
| Current and history of ischaemic heart disease | 1 | I | C | I | C | 3 | I | C | 4 | |
| 2 | 3 | 2 | 3 | 2 | 3 | |||||
| Stroke (history of cerebrovascular accident, including TIA) | 1 | I | C | I | C | 3 | I | C | 4 | |
| 2 | 3 | 2 | 3 | 2 | 3 | |||||
| Known dyslipidaemias | 1 | 2 | 2 | 2 | 2 | 2 | ||||
| Venous thromboembolism | ||||||||||
| (a) History of VTE | 1 | 2 | 2 | 2 | 2 | 4 | ||||
| (b) Current VTE (on anticoagulants) | 1 | 2 | 2 | 2 | 2 | 4 | ||||
| (c) Family history of VTE | ||||||||||
| (i) First-degree relative age <45 years | 1 | 1 | 1 | 1 | 1 | 3 | ||||
| (ii) First-degree relative age ≥45 years | 1 | 1 | 1 | 1 | 1 | 2 | ||||
| (d) Major surgery | ||||||||||
| (i) With prolonged immobilisation | 1 | 2 | 2 | 2 | 2 | 4 | ||||
| (ii) Without prolonged immobilisation | 1 | 1 | 1 | 1 | 1 | 2 | ||||
| (e) Minor surgery without immobilisation | 1 | 1 | 1 | 1 | 1 | 1 | ||||
| (f) Immobility (unrelated to surgery) (for example wheelchair use, debilitating illness) | 1 | 1 | 1 | 1 | 1 | 3 | ||||
| Superficial venous thrombosis | ||||||||||
| (a) Varicose veins | 1 | 1 | 1 | 1 | 1 | 1 | ||||
| (b) Superficial venous thrombosis | 1 | 1 | 1 | 1 | 1 | 2 | ||||
| Known thrombogenic mutations (for example factor V Leiden, prothrombin mutation, protein S, protein C and antithrombin deficiencies) | 1 | 2 | 2 | 2 | 2 | 4 | ||||
| Valvular and congenital heart disease | ||||||||||
| (a) Uncomplicated | 1 | 1 | 1 | 1 | 1 | 2 | ||||
| (b) Complicated (for example pulmonary hypertension, history of subacute bacterial endocarditis) | 2 | 2 | 1 | 1 | 1 | 4 | ||||
| Cardiomyopathy | ||||||||||
| (a) Normal cardiac function | 1 | 1 | 1 | 1 | 1 | 2 | ||||
| (b) Impaired cardiac function | 2 | 2 | 2 | 2 | 2 | 4 | ||||
| Cardiac arrhythmias | ||||||||||
| (a) Atrial fibrillation | 1 | 2 | 2 | 2 | 2 | 4 | ||||
| (b) Known long QT syndrome | I | C | I | C | 1 | 2 | 1 | 2 | ||
| 3 | 1 | 3 | 1 | |||||||
| CVD=cardiovascular disease; BP=blood pressure; TIA=transient ischaemic attack; VTE=venous thromboembolism. | ||||||||||
Neurological Conditions
| CONDITION | Cu-IUD | LNG-IUS | IMP | DMPA | POP | CHC | ||
|---|---|---|---|---|---|---|---|---|
| NEUROLOGICAL CONDITIONS | ||||||||
| Headaches | ||||||||
| (a) Non-migrainous (mild or severe) | 1 | 1 | 1 | 1 | 1 | I | C | |
| 1 | 2 | |||||||
| (b) Migraine without aura, at any age | 1 | 2 | 2 | 2 | I | C | I | C |
| 1 | 2 | 2 | 3 | |||||
| (c) Migraine with aura, at any age | 1 | 2 | 2 | 2 | 2 | 4 | ||
| (d) History (≥5 years ago) of migraine with aura, any age | 1 | 2 | 2 | 2 | 2 | 3 | ||
| Idiopathic intracranial hypertension | 1 | 1 | 1 | 1 | 1 | 2 | ||
| Epilepsy | 1 | 1 | 1 | 1 | 1 | 1 | ||
| Taking anti-epileptic drugs | Certain anti-epileptic drugs have the potential to affect the bioavailability of steroid hormones in hormonal contraception. For up-to-date information on the potential drug interactions between hormonal contraception and anti-epileptic drugs, please refer to the online drug interaction checker available on the Medscape website (reference.medscape.com/drug-interactionchecker interaction checker) | |||||||
Depressive Disorders
| CONDITION | Cu-IUD | LNG-IUS | IMP | DMPA | POP | CHC |
| DEPRESSIVE DISORDERS | ||||||
| Depressive disorders | 1 | 1 | 1 | 1 | 1 | 1 |
Reproductive Tract Conditions
| CONDITION | Cu-IUD | LNG-IUS | IMP | DMPA | POP | CHC | ||
|---|---|---|---|---|---|---|---|---|
| REPRODUCTIVE TRACT CONDITIONS | ||||||||
| Vaginal bleeding patterns | ||||||||
| a) Irregular pattern without heavy bleeding | 1 | 1 | 2 | 2 | 2 | 1 | ||
| b) Heavy or prolonged bleeding (includes regular and irregular patterns) | 2 | I | C | 2 | 2 | 2 | 1 | |
| 1 | 2 | |||||||
| Unexplained vaginal bleeding (suspicious for serious condition) before evaluation | I | C | I | C | 3 | 3 | 2 | 2 |
| 4 | 2 | 4 | 2 | |||||
| Cervical cancer | ||||||||
| (a) Awaiting treatment | I | C | I | C | 2 | 2 | 1 | 2 |
| 4 | 2 | 4 | 2 | |||||
| b) Radical trachelectomy | 3 | 3 | 2 | 2 | 1 | 2 | ||
| Endometrial cancer | I | C | I | C | 1 | 1 | 1 | 1 |
| 4 | 2 | 4 | 2 | |||||
| Uterine fibroids | ||||||||
| a) Without distortion of the uterine cavity | 1 | 1 | 1 | 1 | 1 | 1 | ||
| b) With distortion of the uterine cavity | 3 | 3 | 1 | 1 | 1 | 1 | ||
| Anatomical abnormalities | ||||||||
| a) Distorted uterine cavity | 3 | 3 | ||||||
| b) Other abnormalities | 2 | 2 | ||||||
| Pelvic inflammatory disease | ||||||||
| a) Past PID (assuming no current risk factor for STIs) | 1 | 1 | 1 | 1 | 1 | 1 | ||
| b) Current PID | I | C | I | C | 1 | 1 | 1 | 1 |
| 4 | 2 | 4 | 2 | |||||
| Sexually transmitted infections (STIs) | ||||||||
| a) Chlamydial infection (current) | I | C | I | C | ||||
| i) Symptomatic | 4 | 2 | 4 | 2 | 1 | 1 | 1 | 1 |
| ii) Asymptomatic | 3 | 2 | 3 | 2 | 1 | 1 | 1 | 1 |
| b) Purulent cervicitis or gonorrhoea (current) | 4 | 2 | 4 | 2 | 1 | 1 | 1 | 1 |
| ||||||||
| PID=pelvic inflammatory disease. | ||||||||
Breast Conditions
| CONDITION | Cu-IUD | LNG-IUS | IMP | DMPA | POP | CHC | |
|---|---|---|---|---|---|---|---|
| BREAST CONDITIONS | |||||||
| (a) Undiagnosed mass/breast symptoms | 1 | 2 | 2 | 2 | 2 | I | C |
| 3 | 2 | ||||||
| (b) Benign breast conditions | 1 | 1 | 1 | 1 | 1 | 1 | |
| (c) Family history of breast cancer | 1 | 1 | 1 | 1 | 1 | 1 | |
| (d) Carriers of known gene mutations associated with breast cancer (for example BRCA1/BRCA2) | 1 | 2 | 2 | 2 | 2 | 3 | |
| (e) Breast cancer | |||||||
| (i) Current breast cancer | 1 | 4 | 4 | 4 | 4 | 4 | |
| (ii) Past breast cancer | 1 | 3 | 3 | 3 | 3 | 3 | |
Infection
| CONDITION | Cu-IUD | LNG-IUS | IMP | DMPA | POP | CHC | |||
|---|---|---|---|---|---|---|---|---|---|
| INFECTION | |||||||||
| HIV Infection | |||||||||
| (a) High risk of HIV infection | 1 | 1 | 1 | 1 | 1 | 1 | |||
| (b) HIV infected | |||||||||
| (i) CD4 count ≥200 cells/mm3 | 2 | 2 | 1 | 1 | 1 | 1 | |||
| (ii) CD4 count <200 cells/mm3 | I | C | I | C | 1 | 1 | 1 | 1 | |
| 3 | 2 | 3 | 2 | ||||||
| (c) Taking antiretroviral drugs | Certain ARV drugs have the potential to affect the bioavailability of steroid hormones in hormonal contraception. For up-to-date information on the potential drug interactions between hormonal contraception and ARV drugs, please refer to the online HIV drugs interaction checker (www.hiv-druginteractions.org) | ||||||||
| Tuberculosis | |||||||||
| (a) Non-pelvic | 1 | 1 | 1 | 1 | 1 | 1 | |||
| (b) Pelvic | I | C | I | C | 1 | 1 | 1 | 1 | |
| 4 | 3 | 4 | 3 | ||||||
| Viral hepatitis | |||||||||
| (a) Acute or flare | 1 | 1 | 1 | 1 | 1 | I | C | ||
| 3 | 2 | ||||||||
| (b) Carrier | 1 | 1 | 1 | 1 | 1 | 1 | |||
| (c) Chronic | 1 | 1 | 1 | 1 | 1 | 1 | |||
| ARV=antiretroviral. | |||||||||
Endocrine Conditions
| CONDITION | Cu-IUD | LNG-IUS | IMP | DMPA | POP | CHC |
|---|---|---|---|---|---|---|
| ENDOCRINE CONDITIONS | ||||||
| Diabetes | ||||||
| (a) History of gestational disease | 1 | 1 | 1 | 1 | 1 | 1 |
| (b) Non-vascular disease | ||||||
| (i) Non-insulin dependent | 1 | 2 | 2 | 2 | 2 | 2 |
| (i) Insulin dependent | 1 | 2 | 2 | 2 | 2 | 2 |
| (c) Nephropathy/retinopathy/neuropathy | 1 | 2 | 2 | 2 | 2 | 3 |
| (d) Other vascular disease | 1 | 2 | 2 | 2 | 2 | 3 |
| Please refer to the full guideline for recommendations on thyroid disorders | ||||||
Gastrointestinal Conditions
| CONDITION | Cu-IUD | LNG-IUS | IMP | DMPA | POP | CHC |
|---|---|---|---|---|---|---|
| GASTROINTESTINAL CONDITIONS | ||||||
| Thyroid disease | ||||||
| a) Symptomatic | ||||||
| i) Treated by cholecystectomy | 1 | 2 | 2 | 2 | 2 | 2 |
| ii) Medically treated | 1 | 2 | 2 | 2 | 2 | 3 |
| iii) current | 1 | 2 | 2 | 2 | 2 | 3 |
| b) Asymptomatic | 1 | 2 | 2 | 2 | 2 | 2 |
| History of cholestasis | ||||||
| a) Pregnancy related | 1 | 1 | 1 | 1 | 1 | 2 |
| b) Past COC related | 1 | 2 | 2 | 2 | 2 | 3 |
| Cirrhosis | ||||||
| a) Mild (compensated without complications) | 1 | 1 | 1 | 1 | 1 | 1 |
| b) Severe (decompensated) | 1 | 3 | 3 | 3 | 3 | 4 |
| Please refer to the full guideline for recommendations on liver tumours and inflammatory bowel disease COC=combined oral contraceptive | ||||||
Anaemias
| ANAEMIAS |
|---|
| Please refer to the full guideline for recommendations on thalassaemia, sickle cell disease, and iron deficiency anaemia |
Rheumatic Diseases
| CONDITION | Cu-IUD | LNG-IUS | IMP | DMPA | POP | CHC |
|---|---|---|---|---|---|---|
| RHEUMATIC DISEASES | ||||||
| Rheumatoid arthritis | 1 | 2 | 2 | 2 | 2 | 2 |
| Systemic lupus erythematosus (SLE) | ||||||
| (a) No antiphospholipid antibodies | 1 | 2 | 2 | 2 | 2 | 2 |
| (b) Positive antiphospholipid antibodies | 1 | 2 | 2 | 2 | 2 | 4 |
| Positive antiphospholipid antibodies | 1 | 2 | 2 | 2 | 2 | 4 |
References
References