UK Medical Eligibility for Contraceptive Use 2016

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For women with obesity (BMI categories of >=30-34 kg/m2 and >=35 kg/m2) without coexistent medical conditions Multiple risk factors for CVD (such as smoking, diabetes, hypertension, obesity and dyslipidaemias) The UK MEC helps clinicians decide what contraceptives they are able to safely recommend based on the medical conditions of patients in their care.

You can also find out where to get emergency contraception – the "morning after pill" or the IUD (coil). Common questions about contraception Find out more in Which method suits me? Where you can get contraception and emergency contraception In addition there are categories for Initiation of a method by a woman with a specific condition and Continuation of a method in a woman who develops a new medical condition. What does all this mean in practice? It aims to give practical information to everyone who wants to know more about contraception, or who may have a question about the method they use or are thinking about using. 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 GuidelineContraception is free on the NHS. Find out where to get contraception and search by postcode to find: FSRH CEU Statement: Combined oral contraceptive interference with the ability of ulipristal acetate to delay ovulation: A prospective cohort study (August 2018)

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 For women with raised BMI with other risk factors for CVD in addition to obesity (e.g. smoking, diabetes, hypertension and dyslipidaemias) This guidance provides evidence-based recommendations and good practice points for health professionals on the use of combined hormonal contraceptives (i.e. the combined oral contraceptive pill, transdermal patch and combined vaginal ring) currently available in the UK. It is intended for any health care professional or health service providing contraception or conception advice in the UK. 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/m 2 (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 A woman who has had a stroke in the past can generally start and use the progestogen only pill (UKMEC 2 - Initiation) but if she has a stroke while already using it this becomes a UKMEC 3 for Continuation and would require expert clinical management. What does it not do?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 Looking at a combined hormonal method a woman with a BMI of 30 would be a UKMEC 2 (generally use) but if she had a BMI of 35 this would be a UKMEC 3 (probably don’t use); a woman who has migraine with aura would be a UKMEC 4 (Do Not Use); 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. 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 FSRH CEU Statement: Response to Study Contemporary Hormonal Contraception and the Risk of Breast Cancer (December 2017)