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The Nexplanon implant and the UKMEC
The UK Medical Eligibility Criteria for Contraceptive Use (UKMEC) are an UK-specific adaptation of global criteria on contraceptive use set by the World Health Organization.36, 37 These criteria allocate the use of common reversible contraceptive methods, including the contraceptive implant, Nexplanon, in certain medical conditions into one of four categories.15
The UKMEC criteria can be used to guide women in finding the best choice of contraception that not only fits with their current lifestyles and life stages but also with their medical history.15 Eligibility criteria for use of the contraceptive implant are summarised below.15, 16 Please refer to the full UKMEC for more information.
Medical eligibility and the contraceptive implant16
UKMEC Category 1
A condition for which there is no restriction for the use of the contraceptive method »
- Age
- Parity
- Breastfeeding
- Postpartum (not breastfeeding)
- Post termination
- Past ectopic pregnancy
- History of pelvic surgery
- Smoking
- Obesity
- Hypertension
- History of high blood pressure during pregnancy
- Family history of VTE
- Surgery (major with prolonged immobilization and minor without immobiliation)
- Immobility unrelated to surgery
- Varicose veins
- Superficial thrombophlebitis
- Heart disease (valvular and congential)
- Headache (non-migrainous, mild or severe)
- Epilepsy and not taking liver enzyme-inducing drugs
- Depressive disorders
- Endometriosis
- Benign ovarian tumour
- Severe dysmenorrhoea
- Gestational trophoblastic anaemia (when hCG is normal)
- Cervical ectropion
- Cervical intra-epithelial neoplasia
- Breast disease (benign or family history)
- Endometrial or ovarian cancer
- Uterine fibroids
- Infections (pelvic, sexually transmitted, HIV/AIDS, viral hepatitis - carrier)
- Schistosomiasis, tuberculosis, malaria
- Diabetes (history of gestational disease)
- Thyroid disorders
- History of cholestasis
- Inflammatory bowel disease
- Anaemias
- Raynaud's disease
- Non–liver inducing antibiotic use
UKMEC Category 2
- Multiple risk factors for arterial cardiovascular disease
- Hypertension (vascular disease)
- Past history of VTE
- Major surgery with prolonged immobilisation
- Known thrombogenic mutations
- Current and history of ischaemic heat disease (initiation)
- Stroke (initiation)
- Known hyperlipidaemia
- Migraine headaches (without aura at any age, with aura at any age – initiation, past history of aura at any age)
- Vaginal bleeding (irregular or prolonged, unsuspicious)
- Cervical cancer
- Breast disease (undiagnosed mass, genetic predisposition)
- HIV/AIDS, use of HAART
- Diabetes (non-insulin and insulin-dependent, with microvascular disease or other vascular disease of more than 20 years duration)
- Gallbladder disease
- History of cholestasis
- Cirrhosis (mild compensated disease)
- Raynaud's disease (secondary with lupus anticoagulant)
UKMEC Category 3
- Current VTE (on anticoagulants)
- Current/arising ischaemic heart disease (continuation)
- Stroke (continuation)
- Migraine headaches – with aura at any age (continuation)
- Unexplained vaginal bleeding
- Viral hepatitis (active disease)
- Cirrhosis (severe decompensated disease)
- Liver tumours (benign and malignant)
- Drugs which induce liver enzymes (e.g. rifampicin, St John’s Wort, certain anticonvulsants)
UKMEC Category 4
A condition which represents an unacceptable health risk if the contraceptive method is used »
- Breast disease (Current breast cancer)
HAART, highly active anti-retroviral therapy; hCG, human chorionic gonadotropin; VTE, venous thromboembolism
