Combined oral contraceptive pill: contraindications

Combined oral contraceptive pill: contraindications

The decision of whether to start a women on the combined oral contraceptive pill is now guided by the UK Medical Eligibility Criteria (UKMEC). This scale categorises the potential cautions and contraindications according to a four point scale, as detailed below:

• UKMEC 1: a condition for which there is no restriction for the use of the contraceptive method
• UKMEC 2: advantages generally outweigh the disadvantages
• UKMEC 3: disadvantages generally outweigh the advantages
• UKMEC 4: represents an unacceptable health risk

Examples of UKMEC 3 conditions include

• more than 35 years old and smoking less than 15 cigarettes/day
  more than 35 years old and smoking less than 15 cigarettes/day
  You've never been tested on this concept
  You've not yet rated this concept.
• BMI > 35 kg/m^2
  BMI > 35 kg/m^2
  You've never been tested on this concept
  You've not yet rated this concept.
  *
• family history of thromboembolic disease in first degree relatives < 45 years
  family history of thromboembolic disease in first degree relatives < 45 years
  You've never been tested on this concept
  You've not yet rated this concept.
• controlled hypertension
  controlled hypertension
  You've never been tested on this concept
  You've not yet rated this concept.
• immobility e.g. wheel chair use
  immobility e.g. wheel chair use
  You've never been tested on this concept
  You've not yet rated this concept.
• carrier of known gene mutations associated with breast cancer (e.g. BRCA1/BRCA2)
  carrier of known gene mutations associated with breast cancer (e.g. BRCA1/BRCA2)
  You've never been tested on this concept
  You've not yet rated this concept.
• current gallbladder disease
  current gallbladder disease
  You've never been tested on this concept
  You've not yet rated this concept.

Examples of UKMEC 4 conditions include

• more than 35 years old and smoking more than 15 cigarettes/day
  more than 35 years old and smoking more than 15 cigarettes/day
  You've never been tested on this concept
  You've not yet rated this concept.
• migraine with aura
  migraine with aura
  You've never been tested on this concept
  You've not yet rated this concept.
• history of thromboembolic disease or thrombogenic mutation
  history of thromboembolic disease or thrombogenic mutation
  You've never been tested on this concept
  You've not yet rated this concept.
• history of stroke or ischaemic heart disease
  history of stroke or ischaemic heart disease
  You've never been tested on this concept
  You've not yet rated this concept.
• breast feeding < 6 weeks post-partum
  breast feeding < 6 weeks post-partum
  You've never been tested on this concept
  You've not yet rated this concept.
• uncontrolled hypertension
  uncontrolled hypertension
  You've never been tested on this concept
  You've not yet rated this concept.
• current breast cancer
  current breast cancer
  You've never been tested on this concept
  You've not yet rated this concept.
• major surgery with prolonged immobilisation
  major surgery with prolonged immobilisation
  You've never been tested on this concept
  You've not yet rated this concept.
• positive antiphospholipid antibodies (e.g. in SLE)
  positive antiphospholipid antibodies (e.g. in SLE)
  You've never been tested on this concept
  You've not yet rated this concept.

Diabetes mellitus diagnosed > 20 years ago is classified as UKMEC 3 or 4 depending on severity

Changes in 2016

• breast feeding 6 weeks - 6 months postpartum
  breast feeding 6 weeks - 6 months postpartum
  You've never been tested on this concept
  You've not yet rated this concept.
  was changed from UKMEC 3 → 2

+PassMedicine Notes

The decision of whether to start a women on the combined oral contraceptive pill is now guided by the UK Medical Eligibility Criteria (UKMEC). This scale categorises the potential cautions and contraindications according to a four point scale, as detailed below:

• UKMEC 1: a condition for which there is no restriction for the use of the contraceptive method
• UKMEC 2: advantages generally outweigh the disadvantages
• UKMEC 3: disadvantages generally outweigh the advantages
• UKMEC 4: represents an unacceptable health risk

Examples of UKMEC 3 conditions include

• more than 35 years old and smoking less than 15 cigarettes/day
• BMI > 35 kg/m^2*
• family history of thromboembolic disease in first degree relatives < 45 years
• controlled hypertension
• immobility e.g. wheel chair use
• carrier of known gene mutations associated with breast cancer (e.g. BRCA1/BRCA2)
• current gallbladder disease

Examples of UKMEC 4 conditions include

• more than 35 years old and smoking more than 15 cigarettes/day
• migraine with aura
• history of thromboembolic disease or thrombogenic mutation
• history of stroke or ischaemic heart disease
• breast feeding < 6 weeks post-partum
• uncontrolled hypertension
• current breast cancer
• major surgery with prolonged immobilisation
• positive antiphospholipid antibodies (e.g. in SLE)

Diabetes mellitus diagnosed > 20 years ago is classified as UKMEC 3 or 4 depending on severity

Changes in 2016

• breast feeding 6 weeks - 6 months postpartum was changed from UKMEC 3 --> 2