FSRH | UKMEC update (risks of various contraceptive use)

The UKMEC criteria from the FSRH have been updated. These criteria tell you what conditions or criteria may make the use of different contraceptives inappropriate. If you are not familiar with it, it is a fantastic resource and well worth consulting when a woman has a condition which could affect her use of contraception.

I'm not going to list all the changes, just ones that I think we are likely to come across a lot. I have also added some things that I hadn't been aware of, even if they are not a change.

What do the UKMEC criteria mean?

  • UKMEC-1 | No restriction on use
  • UKMEC-2 | Advantages of use of the method generally outweigh the proven or theoretical risks
  • UKMEC-3 | Risks usually outweigh the benefits. Use requires 'expert clinical judgement' and/or referral to a specialist contraceptive provider. Use would not be recommended unless other methods are not available or acceptable.
  • UKMEC-4 | Unacceptable health risk

COC and breastfeeding

  • From 6 weeks to 6 months is now considered UKMEC 2 (rather than 3) for the COC. Good news for lots of breastfeeding women! Basically there is conflicting evidence from trials on whether use of the COC before 6 weeks post-partum has adverse effects. However there are no studies showing adverse effects on infant growth where the COC has been initiated after 6 weeks. If anyone is dubious and wants to see more evidence, the abstract can be accessed here.

Multiple cardiovascular risk factors

  • Eg smoking, obesity, diabetes, hypertension or dyslipidaemias. Where there are several risk factors, the COC and the depot injection are UKMEC 3.

Hypertension

  • Even adequately controlled hypertension with COC is UKMEC 3 (though the full criteria are a little vague about what adequately controlled hypertension actually is).

Ischaemic heart disease

  • Current IHD, or a history of IHD, is UKMEC 3 for continuation of the mirena coil, the implant and the POP. It is only UKMEC 2 for initiation of these methods. It is UKMEC 4 for the COC. It is UKMEC 3 for the depot.

CVA

  • The same applies as for IHD.

Migraine

  • Migraine without aura, at any age, is UKMEC 3 for continuation of the COC (but UKMEC 2 for its initiation).
  • A history of migraine with aura 5 or more years ago is UKMEC 3 for COC (migraine with aura in the last 5 years  is UKMEC 4).
  • Unsure what constitutes an aura? If you have a woman who has symptoms you are not sure about, check the following website from the International Headache Society (as advised by the FSRH). Of note, in the previous UKMEC criteria from 2009, flashing lights were specifically stated as not being aura, but the IHS criteria advise that 'flickering lights' are part of an aura.

Diabetes

  • With nephropathy, retinopathy, neuropathy or other vascular disease is UKMEC 3 for the COC.

Gallbladder disease

  • Symptomatic gallbladder disease, either medically treated, or current is UKMEC 3 for the COC. If treated by cholecystectomy it is UKMEC 2.

Antiphospholipid antibodies

  • Women with antiphospholipid antibodies, whether with SLE or not, is UKMEC 4 for the COC.

Family history of breast cancer

  • This is UKMEC 1 for all methods.

Louise Hudman

I'm a freelance GP locum in Winchester & Southampton.

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