UKMEC SUMMARY TABLE HORMONAL AND INTRAUTERINE …

1 UKMEC SUMMARY TABLE HORMONALAND INTRAUTERINE CONTRACEPTIONCu-IUD = Copper-bearing INTRAUTERINE device; LNG-IUS = Levonorgestrel-releasing INTRAUTERINE system;IMP = Progestogen-only implant; DMPA = Progestogen-only injectable: depot medroxyprogesterone acetate;POP = Progestogen-only pill; CHC = Combined HORMONAL contraceptionCONDITIONCu-IUDLNG-IUSIMPDM PAPOPCHCI = Initiation, C = ContinuationPERSONAL CHARACTERISTICS AND REPRODUCTIVE HISTORYP regnancyNANANANANANAAgeMenarche to <20=2, 20=1 Menarcheto <20=2, 20=1 After menarche =1 Menarche to <18=2, 18-45=1,>45=2 After menarche =1 Menarcheto <40=1, 40=2 Paritya) Nulliparous111111b) Parous111111 Breastfeedinga) 0 to <6 weeks postpartumSee below1214b) 6 weeks to <6 months(primarily breastfeeding)1112c) 6 months postpartum1111 Postpartum (in non-breastfeeding women)a) 0 to <3 weeks(i) With other risk factors for VTESee below1214(ii)

2 Without other risk factors1213b) 3 to <6 weeks(i) With other risk factors for VTESee below1213(ii) Without other risk factors1112c) 6 weeks111101 Copyright Faculty of Sexual and Reproductive Healthcare 2006 to of categoryCategory 1A condition for which there is no restriction for the use of the methodCategory 2A condition where the advantages of using the method generally outweigh the theoretical or proven risksCategory 3A 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 acceptableCategory 4A condition which represents an unacceptable health risk if the method is usedUKMEC SUMMARY TABLE (AMENDED SEPTEMBER 2019)Postpartum (in breastfeeding or non-breastfeeding women, including post-caesarean section)a) 0 to <48 hours11 See aboveb) 48 hours to <4 weeks33c) 4 weeks11d) Postpartum sepsis44 Post-abortiona) First trimester111111b)

3 Second trimester221111c) Post-abortion sepsis441111 Past ectopic pregnancy111111 History of pelvic surgery111111 UKMECD efinition of categoryCategory 1A condition for which there is no restriction for the use of the methodCategory 2A condition where the advantages of using the method generally outweigh the theoretical or proven risksCategory 3A 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 acceptableCategory 4A condition which represents an unacceptable health risk if the method is usedCopyright Faculty of Sexual and Reproductive Healthcare 2006 to ) Age <35 years111112b) Age 35 years(i) <15 cigarettes/day111113(ii) 15 cigarettes/day111114(iii) Stopped smoking <1 year111113(iv) Stopped smoking 1 year111112 Obesitya)BMI 30 34 kg/m2111112b)

4 BMI 35 kg/m2111113 UKMEC SUMMARY TABLE HORMONAL AND INTRAUTERINE CONTRACEPTIONCONDITIONCu-IUDLNG-IUSIMPDM PAPOPCHCI = Initiation, C = Continuation02 UKMEC SUMMARY TABLE (AMENDED SEPTEMBER 2019)UKMECD efinition of categoryCategory 1A condition for which there is no restriction for the use of the methodCategory 2A condition where the advantages of using the method generally outweigh the theoretical or proven risksCategory 3A 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 acceptableCategory 4A condition which represents an unacceptable health risk if the method is usedCopyright Faculty of Sexual and Reproductive Healthcare 2006 to 2016.

5 UKMEC SUMMARY TABLE HORMONAL AND INTRAUTERINE CONTRACEPTIONCONDITIONCu-IUDLNG-IUSIMPDM PAPOPCHCI = Initiation, C = ContinuationHistory of bariatric surgerya) With BMI <30 kg/m2111111b) With BMI 30 34 kg/m2111112c) With BMI 35 kg/m2111113 Organ transplanta) Complicated: graft failure (acute orchronic), rejection, cardiac allograftvasculopathyICIC22233232b) Uncomplicated222222 CARDIOVASCULAR DISEASE (CVD)Multiple risk factors for CVD (such as smoking, diabetes, hypertension, obesity and dyslipidaemias)122323 Hypertensiona) Adequately controlled hypertension111213b) Consistently elevated BP levels(properly taken measurements)(i) Systolic >140 159 mmHg ordiastolic >90 99 mmHg111113(ii) Systolic 160 mmHg ordiastolic 100 mmHg111214c)

6 Vascular disease122324 History of high BP during pregnancy111112 Current and history of ischaemic heart disease1 ICIC3IC42323 23 Stroke (history of cerebrovascular accident, including TIA)1 ICIC3IC4232323 Known dyslipidaemias12222203 UKMEC SUMMARY TABLE (AMENDED SEPTEMBER 2019)UKMECD efinition of categoryCategory 1A condition for which there is no restriction for the use of the methodCategory 2A condition where the advantages of using the method generally outweigh the theoretical or proven risksCategory 3A condition where the theoretical or proven risks usually outweigh the advantages of using the method.

7 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 acceptableCategory 4A condition which represents an unacceptable health risk if the method is usedVenous thromboembolism (VTE)a) History of VTE122224b) Current VTE (on anticoagulants)122224c) Family history of VTE(i) First-degree relative age <45 years111113(ii) First-degree relative age 45 years111112d) Major surgery(i) With prolonged immobilisation122224(ii) Without prolonged immobilisation111112e) Minor surgery without immobilisation111111f) Immobility (unrelated to surgery) ( use, debilitating illness)111113 Superficial venous thrombosisa) Varicose veins111111b) Superficial venous thrombosis111112 Known thrombogenic mutations ( factor V Leiden, prothrombin mutation, protein S, protein C and antithrombin deficiencies)

8 122224 UKMEC SUMMARY TABLE HORMONAL AND INTRAUTERINE CONTRACEPTIONCONDITIONCu-IUDLNG-IUSIMPDM PAPOPCHCI = Initiation, C = Continuation04 Copyright Faculty of Sexual and Reproductive Healthcare 2006 to SUMMARY TABLE (AMENDED SEPTEMBER 2019)UKMECD efinition of categoryCategory 1A condition for which there is no restriction for the use of the methodCategory 2A condition where the advantages of using the method generally outweigh the theoretical or proven risksCategory 3A 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 acceptableCategory 4A condition which represents an unacceptable health risk if the method is usedValvular and congenital heart diseasea) Uncomplicated111112b) Complicated ( pulmonaryhypertension, history of subacutebacterial endocarditis)221114 Cardiomyopathya) Normal cardiac function111112b) Impaired cardiac function222224 Cardiac arrhythmiasa)

9 Atrial fibrillation122224b) Known long QT syndromeICIC12123131 NEUROLOGICAL CONDITIONSH eadachesa) Non-migrainous (mild or severe)11111IC12b) Migraine without aura, at any age1222 ICIC1223c) Migraine with aura, at any age122224d) History ( 5 years ago) of migrainewith aura, any age122223 UKMEC SUMMARY TABLE HORMONAL AND INTRAUTERINE CONTRACEPTIONCONDITIONCu-IUDLNG-IUSIMPDM PAPOPCHCI = Initiation, C = Continuation05 Copyright Faculty of Sexual and Reproductive Healthcare 2006 to SUMMARY TABLE (AMENDED SEPTEMBER 2019)Idiopathic intracranial hypertension (IIH)111112 Epilepsy111111 Taking anti-epileptic drugsCertain anti-epileptic drugs have the potential to affect the bioavailability of steroid hormones in HORMONAL 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 available on Stockley s Interaction Checker website ( ).

10 DEPRESSIVE DISORDERSD epressive disorders111111 BREAST AND REPRODUCTIVE TRACT CONDITIONSV aginal bleeding patternsa) Irregular pattern without heavy bleeding112221b) Heavy or prolonged bleeding (includesregular and irregular patterns)2IC222112 Unexplained vaginal bleeding (suspicious for serious condition) before evaluationICIC33224242 Endometriosis211111 Benign ovarian tumours (including cysts)111111 Severe dysmenorrhoea211111 Gestational trophoblastic disease (GTD) a) Undetectable hCG levels111111b) Decreasing hCG levels331111c) Persistently elevated hCG levels ormalignant disease441111 UKMECD efinition of categoryCategory 1A condition for which there is no restrict