Guideline of the month - medical eligibility for contraceptive use

The guideline

The updated UK Medical Eligibility Criteria (UKMEC) guidance, from the Faculty of Sexual and Reproductive Healthcare, revamps previous advice on the use of contraception in existing or newly acquired medical conditions. Four categories are used: UKMEC 1 and 2 ‘do not hinder’ provision, UKMEC 3 requires ‘expert opinion’ and UKMEC 4 denotes ‘absolute contraindication’.

Key points for GPs

• Medical conditions added: bariatric surgery; organ transplantation; cardiomyopathy; cardiac arrhythmias (including long QT interval); HIV infection with CD4 count <200 (replaces AIDS); and rheumatoid arthritis.

• New UKMEC 3 or 4:

– Copper IUD or levonorgestrel-IUS for women with: organ transplant with complications; prolonged QT interval; or HIV infection with a CD4 count <200.

– Combined hormonal contraception (CHC) for: non-breastfeeders with additional VTE risk factors up to six weeks postpartum; women with cardiomyopathy with impaired cardiac function; atrial fibrillation; or organ transplantation with complications.

• No longer UKMEC 3 or 4:

– IUD or IUS for women with ovarian cancer or lupus with low platelets or antiphospholipid antibodies.

– CHC for breastfeeders after six weeks postpartum.

Practical issues

• Depot norethisterone enanthate has been removed, but DMPA will now apply to Sayana Press as well as Depo-Provera.

• Fitting coils in women with prolonged QT interval is an important new caution, but no mention is made of drugs that may cause or exacerbate this problem.

Expert comment

Dr Jenny Brotherston, a GPSI in sexual and reproductive healthcare in Hull, says: ‘This is robustly evidence based, but some issues are not addressed. The FSRH and the MHRA advise stopping DMPA or CHC at age 50, but this is not reflected in the updated guidance. GPs are generally advised against DMPA if there are osteoporosis risk factors, yet the UKMEC caution only covers high BMI, not low BMI or other risk factors.’