fsrh-ukmec-full-book-2019.pdf
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About This Presentation
Contraception
Slide Content
y
\ FSRH ka teatheare
UK MEDICAL ELIGIBILITY CRITERIA
FOR CONTRACEPTIVE USE | UKMEC 2016
(AMENDED SEPTEMBER 2019)
\ FSRH ka teatheare
UK MEDICAL ELIGIBILITY CRITERIA
FOR CONTRACEPTIVE USE | UKMEC 2016
(AMENDED SEPTEMBER 2019)
FSH povided funding o ta Cll Ecrans Union SRH)
to aroma production of th guidance, the UK Mocca ig for Cornet Ur 2010)
Pubhod bythe Facuy of Sul and RaproduciveHaatheare
again Eng No, 2804213 and agitar Charty No 1019949
UNES se pubnhedin Ju 2006
Copie Faculty Seal aná aprecio Heather 20061018 Nay 2016.
Th documar le aalabla gray on arma tano
Parmasen is anta reproduce o anim this documa for nn-commarcalpasonaland
roncomimucledvcaton uo ony Comme we any ln ning copia,
ang an ening, probed
Ary rproduction of tha hola of the domar mus products copyright noce in te tity
Any prediction of ptf his document matin statement htt produced under cance
from FRM and the notice Copyright CFacky of Sonal nd producto Mahe 200 12016,
Pabahadinth UC
to aroma production of th guidance, the UK Mocca ig for Cornet Ur 2010)
Pubhod bythe Facuy of Sul and RaproduciveHaatheare
again Eng No, 2804213 and agitar Charty No 1019949
UNES se pubnhedin Ju 2006
Copie Faculty Seal aná aprecio Heather 20061018 Nay 2016.
Th documar le aalabla gray on arma tano
Parmasen is anta reproduce o anim this documa for nn-commarcalpasonaland
roncomimucledvcaton uo ony Comme we any ln ning copia,
ang an ening, probed
Ary rproduction of tha hola of the domar mus products copyright noce in te tity
Any prediction of ptf his document matin statement htt produced under cance
from FRM and the notice Copyright CFacky of Sonal nd producto Mahe 200 12016,
Pabahadinth UC
Details of changes to original document
Since this document was rst published, the following changes have been made
December 2017
"The UKMEC category for use of progestogen-onl injectable contraception by women a high risk of
acquiting HIV has been revised from UKMEC2 (benefits of use generally outweigh risks) to UKMECI
(no restrictions tous).
September 2019
The UKMEC category for use of progestogen-only injectable contracept
contraception by women at high risk of acquiring HIV has been revise from UKMEC2 (benefits of use
generally outweigh risks) to UKMECI (no restrictions to use).
Additional Resource: Diagnosis of Migraine With or Without Aura has been updated to signpost
directly to the International Headache Societys International Classification of Headache Disorders
Grd edition).
Since this document was rst published, the following changes have been made
December 2017
"The UKMEC category for use of progestogen-onl injectable contraception by women a high risk of
acquiting HIV has been revised from UKMEC2 (benefits of use generally outweigh risks) to UKMECI
(no restrictions tous).
September 2019
The UKMEC category for use of progestogen-only injectable contracept
contraception by women at high risk of acquiring HIV has been revise from UKMEC2 (benefits of use
generally outweigh risks) to UKMECI (no restrictions to use).
Additional Resource: Diagnosis of Migraine With or Without Aura has been updated to signpost
directly to the International Headache Societys International Classification of Headache Disorders
Grd edition).
ACTE
SECTION A: INTRODUCTION
The UK Medical Elgbity Criteria for Contraceptive Use (UKMEC)
Development ofthe UKMEC,
Using the UKMEC
Contraceptive Choice
Effeciveness of Contraceptive Method
Drug Interactions wth Hormonal Contraception
Conditions that May Pose a Signficant Heath Risk During Pregnancy
Summary of Changes from UKMEC 2009.
o
or
04
05
or
SECTION A: INTRODUCTION
The UK Medical Elgbity Criteria for Contraceptive Use (UKMEC)
Development ofthe UKMEC,
Using the UKMEC
Contraceptive Choice
Effeciveness of Contraceptive Method
Drug Interactions wth Hormonal Contraception
Conditions that May Pose a Signficant Heath Risk During Pregnancy
Summary of Changes from UKMEC 2009.
o
or
04
05
or
The UK medical eligibility criteria for contraceptive use (UKMEC)
‘The UK Medical Eligibility Criteria for Contraceptive Use (UKMEO) offers guidance to providers
of contraception regarding who can use contraceptive methods safely. 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). The recommendations allow for
‘consideration ofthe possible methods that could be used safely by individuals with certain heath
Conditions (e.g, hypertension) or characteristics (e.g, age) to prevent an unintended pregnancy,
Most contraceptive users are medically fit and can use any available contraceptive method
safely, However, some medical conditions are associated with potential or theoretical increased
health risks when certain contraceptive methods are used, either because the method
‘adversely affects Ihe condition or because the condition or its treatment affects the safety of
the contraceptive. Since most trials of new contraceptive methods deliberately exclude subjects
with chronic medical conditions, there is often litle direct evidence on which to base accurate
prescrbing advice
Development of the UKMEC
‘The World Health Organization (WHO) developed a set of internationally agreed norms for
providing contraception to individuals with a range of medical conditions that may contraindicate
‘one or more contraceptive methods. The first edition of the WHO Medical Eligblity Criteria
for Contraceptive Use (WHOMEC) was published in 1996. The fith edition was published in
201$ and is available on the WHO website.’ The WHOMEC is primarily intended for use in
developing countries where the risks associated with pregnancy are often extremely high but i
is the intention of WHO that the guidance be adapted for use in different settings in which the
risk beneft ratio of contraceptive methods may difr.
“The first edition of the UKMEC was published in 2006 with a grant from the Department of Health
(England) The document was widely distributed to clinicians throughout the United Kingdom
(UK) with funding from the Department of Health (England), the Scottish Executive (Scotland)
and the Faculty of Sexual and Reproductive Healthcare (FSRH). The second edition of the
UKMEC?was published in 2009. UKMEC 2016 supersedes the second version and has taken
‘account of new evidence included in the WHOMEC (ith edition).
‘The UKMEC update was le by the Clinical Effectiveness Unit (CEU) ofthe FSRH and involved a
{guideline development group (GDG) consisting of 19 members (see Appendic 1 for the UKMEC
development process and Appendix 2 for the list of contributors). À formal consensus process!
was used by the GDG with the aim of making the best use of published evidence and capturing
the collective knowledge of experts in the fields of sexual and reproductive health and allied
‘specialties to inform the recommendations included in the UKMEC classifications. The changes
in UKMEC 2016 from UKMEC 2009 are summarised and highlighted at the end of Section A
‘The UK Medical Eligibility Criteria for Contraceptive Use (UKMEO) offers guidance to providers
of contraception regarding who can use contraceptive methods safely. 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). The recommendations allow for
‘consideration ofthe possible methods that could be used safely by individuals with certain heath
Conditions (e.g, hypertension) or characteristics (e.g, age) to prevent an unintended pregnancy,
Most contraceptive users are medically fit and can use any available contraceptive method
safely, However, some medical conditions are associated with potential or theoretical increased
health risks when certain contraceptive methods are used, either because the method
‘adversely affects Ihe condition or because the condition or its treatment affects the safety of
the contraceptive. Since most trials of new contraceptive methods deliberately exclude subjects
with chronic medical conditions, there is often litle direct evidence on which to base accurate
prescrbing advice
Development of the UKMEC
‘The World Health Organization (WHO) developed a set of internationally agreed norms for
providing contraception to individuals with a range of medical conditions that may contraindicate
‘one or more contraceptive methods. The first edition of the WHO Medical Eligblity Criteria
for Contraceptive Use (WHOMEC) was published in 1996. The fith edition was published in
201$ and is available on the WHO website.’ The WHOMEC is primarily intended for use in
developing countries where the risks associated with pregnancy are often extremely high but i
is the intention of WHO that the guidance be adapted for use in different settings in which the
risk beneft ratio of contraceptive methods may difr.
“The first edition of the UKMEC was published in 2006 with a grant from the Department of Health
(England) The document was widely distributed to clinicians throughout the United Kingdom
(UK) with funding from the Department of Health (England), the Scottish Executive (Scotland)
and the Faculty of Sexual and Reproductive Healthcare (FSRH). The second edition of the
UKMEC?was published in 2009. UKMEC 2016 supersedes the second version and has taken
‘account of new evidence included in the WHOMEC (ith edition).
‘The UKMEC update was le by the Clinical Effectiveness Unit (CEU) ofthe FSRH and involved a
{guideline development group (GDG) consisting of 19 members (see Appendic 1 for the UKMEC
development process and Appendix 2 for the list of contributors). À formal consensus process!
was used by the GDG with the aim of making the best use of published evidence and capturing
the collective knowledge of experts in the fields of sexual and reproductive health and allied
‘specialties to inform the recommendations included in the UKMEC classifications. The changes
in UKMEC 2016 from UKMEC 2009 are summarised and highlighted at the end of Section A
TER
USING THE UKMEC
The UKMEC considers the following groups of contraceptive methods: intrauterine contraception
(UC), progestogen-only contraception (POC), combined hormonal contraception (CHC) and
smergency contraception (EC). The UKMEC categories for each of these groups can be found
in Section B, together with evidence summaries and ciarfications. Additional comments can be
found at the end of each method section. References and additional resources are located in
‘Section C, Commonly used abbreviations are listed in Appendix 3.
‘The UKMEC Categories
For each of the personal characteristics or medical conditions considered by the UKMEC a
Category 1, 2, 3 or 4 is given. The definitions of the categories are given in Table 1
Table 1: Definition of UKMEC categories
DEFINITION €
A condition for which there is no restriction for the use of the method
A condition where the advantages of using the method generally outweigh the
theoretical or proven risks
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 andlor referral to a specialist contraceptive provider, since
use ofthe method is not usually recommended unless ather more appropriate
methods are not available or not acceptable
‘Acondition which represents an unacceptable health risk ifthe method is used
When applied ina clinical seting, a UKMEC Category 1 indicates that there is no restriction for
use, AUKMEC Category 2 indicates that the method can generally be used, but more careful
follow-up may be required, A contraceptive method with a UKMEC Category 3 can be used;
however, it may require expert clinical judgement and/or referral to a specialist contraception
provider since use is not usually recommended unless other methods are not available or
acceptable. A UKMEC Category 4 indicates that use in that condition poses an unacceptable
health risk and should not be used,
Initiation and Continuation of a Method
Theinitation(1) and continuation (C) of method of contraception can sometimes be distinguished
and classified differently (see Table 2). 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
USING THE UKMEC
The UKMEC considers the following groups of contraceptive methods: intrauterine contraception
(UC), progestogen-only contraception (POC), combined hormonal contraception (CHC) and
smergency contraception (EC). The UKMEC categories for each of these groups can be found
in Section B, together with evidence summaries and ciarfications. Additional comments can be
found at the end of each method section. References and additional resources are located in
‘Section C, Commonly used abbreviations are listed in Appendix 3.
‘The UKMEC Categories
For each of the personal characteristics or medical conditions considered by the UKMEC a
Category 1, 2, 3 or 4 is given. The definitions of the categories are given in Table 1
Table 1: Definition of UKMEC categories
DEFINITION €
A condition for which there is no restriction for the use of the method
A condition where the advantages of using the method generally outweigh the
theoretical or proven risks
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 andlor referral to a specialist contraceptive provider, since
use ofthe method is not usually recommended unless ather more appropriate
methods are not available or not acceptable
‘Acondition which represents an unacceptable health risk ifthe method is used
When applied ina clinical seting, a UKMEC Category 1 indicates that there is no restriction for
use, AUKMEC Category 2 indicates that the method can generally be used, but more careful
follow-up may be required, A contraceptive method with a UKMEC Category 3 can be used;
however, it may require expert clinical judgement and/or referral to a specialist contraception
provider since use is not usually recommended unless other methods are not available or
acceptable. A UKMEC Category 4 indicates that use in that condition poses an unacceptable
health risk and should not be used,
Initiation and Continuation of a Method
Theinitation(1) and continuation (C) of method of contraception can sometimes be distinguished
and classified differently (see Table 2). 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
Table 2: Initiation and continuation of a method by women with a medical condition
IA String à method by a woman witha specie medical condition |
Continuing with the method already being used by awoman who develops
a new medical condition
Continuation
For example, the intaton of a progestogen-only pill (POP) isnot resticted in a woman with stoke
(cerebrovascular accident) as the advantages of using the method generally outweigh the theoretical
or proven risks (UKMEC 2). However, f à woman has a stroke (cerebrovascular accident) while
using a POR the continuation of the method vil require expert cinical judgement andlor referral to
‘a specialist contraceptive provider because use ofthat method isnot usualy recommended unless
other, more appropriate methods are not available or acceptable (UKMEC 3)
Using the UKMEC Tables
‘The UKMEC tables are set out a follows (rom left to right, see Table 3)
The frst column indicates the CONDITION. Each condition is defined as representing either
an individual's characteristics (eg. age, party) or a known pre-existing medical condition (e.g
diabetes, hypertension). Some conditions are subdivided to differentiate between varying
degrees of the condition (eg. migraine with or without aura).
The CATEGORY (UKMEC 1 to 4) for each CONDITION is given for each method of
contraception. Occasionally, NA (not applicable) is used, which denotes a condition for which
a ranking was not given but for which clarifications have been provided.
“The last column is used to provide CLARIFICATION or to make comment on the EVIDENCE
forthe recommendation where appropriate.
Table 3: Example of tables in UKMEC
RIFICATION/EVIDENCE
tinvation
Clatiications and evidence regarding
the condition or classification
Category 1, 2, 30r 4
IA String à method by a woman witha specie medical condition |
Continuing with the method already being used by awoman who develops
a new medical condition
Continuation
For example, the intaton of a progestogen-only pill (POP) isnot resticted in a woman with stoke
(cerebrovascular accident) as the advantages of using the method generally outweigh the theoretical
or proven risks (UKMEC 2). However, f à woman has a stroke (cerebrovascular accident) while
using a POR the continuation of the method vil require expert cinical judgement andlor referral to
‘a specialist contraceptive provider because use ofthat method isnot usualy recommended unless
other, more appropriate methods are not available or acceptable (UKMEC 3)
Using the UKMEC Tables
‘The UKMEC tables are set out a follows (rom left to right, see Table 3)
The frst column indicates the CONDITION. Each condition is defined as representing either
an individual's characteristics (eg. age, party) or a known pre-existing medical condition (e.g
diabetes, hypertension). Some conditions are subdivided to differentiate between varying
degrees of the condition (eg. migraine with or without aura).
The CATEGORY (UKMEC 1 to 4) for each CONDITION is given for each method of
contraception. Occasionally, NA (not applicable) is used, which denotes a condition for which
a ranking was not given but for which clarifications have been provided.
“The last column is used to provide CLARIFICATION or to make comment on the EVIDENCE
forthe recommendation where appropriate.
Table 3: Example of tables in UKMEC
RIFICATION/EVIDENCE
tinvation
Clatiications and evidence regarding
the condition or classification
Category 1, 2, 30r 4
TER
Itis important to note that the UKMEC c:
+ Relate to the SAFETY of use of a method of contraception by a woman with a particular
medical condition or personal characteristic. The EFFICACY of contraception may be affected
by the condition or by a medication required for the condition but the UKMEC category does
not reflet this.
+ Ate intended to be applied to use ofthe method of contraception for contraceptive purposes.
‘Where a method of contraception is used for a non-contraceptive indication (e.g. management
of heavy menstrual bleeding (HMB)] the rsidbenefit profile and eligibilty criteria may differ.
+ Cannot simply be added together to indicate the safety of using a method. For example, it
‘a woman has two conditions that are each UKMEC 2 for use of CHO, these should not be
added to make a UKMEC 4. However, if multiple UKMEC 2 conditions are present that all
relate tothe 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 CHC who has a body mass index (BM) of 34 kg/m (UKMEC 2), is a current smoker
(UKMEC 2), has a history of superficial venous thrombosis (UKMEC 2), and has a fst-degree
relative who had a venous thromboembolic event at age SO years (UKMEC 2), 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. When an individual
has multiple conditions al scoring UKMEC 3 for a method, use of this method may pose an
unacceptable risk clinical judgement should be used in each individual case.
Contraceptive Choice
Many factors determine the method of contraception an individual chooses to use. Provided
the woman is medically eligible to use a particular method, she should be free to choose the
method that is most acceptable to her. To be effective, contraception must be used correctly and
Consistently. Effective and continued use of a method is direct related tots acceptabilty to the
Women should be given accurate information about all methods for which they are medically
eligible and helped to decide which might best sut their needs. Health professionals who give
advice about contraception should be competent to give information about the efficacy, risks
and side effects, advantages and disadvantages, and non-contraceptive benefits of all available
methods,
Information on contraception for women in the UK can be found on the Family Planning
Association (fpa) website +
Effectiveness of Contraceptive Method
Methods that require consistent and correct use by individuals have a wide range of effectiveness
‘and can vary greatly with characteristics such as age, socioeconomic status, users’ desires to
preventor delay pregnancy, and cuture. Table 4 compares the percentage of women experiencing
an unintended pregnancy during the first year of contraceptive use when the method is used
'ypically (which includes both incorrectand inconsistentuse) or perfectly (correctand consistent
use) Methods considered as long-acting reversible contraception (LARC) are highlighted in
Table 4.
Itis important to note that the UKMEC c:
+ Relate to the SAFETY of use of a method of contraception by a woman with a particular
medical condition or personal characteristic. The EFFICACY of contraception may be affected
by the condition or by a medication required for the condition but the UKMEC category does
not reflet this.
+ Ate intended to be applied to use ofthe method of contraception for contraceptive purposes.
‘Where a method of contraception is used for a non-contraceptive indication (e.g. management
of heavy menstrual bleeding (HMB)] the rsidbenefit profile and eligibilty criteria may differ.
+ Cannot simply be added together to indicate the safety of using a method. For example, it
‘a woman has two conditions that are each UKMEC 2 for use of CHO, these should not be
added to make a UKMEC 4. However, if multiple UKMEC 2 conditions are present that all
relate tothe 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 CHC who has a body mass index (BM) of 34 kg/m (UKMEC 2), is a current smoker
(UKMEC 2), has a history of superficial venous thrombosis (UKMEC 2), and has a fst-degree
relative who had a venous thromboembolic event at age SO years (UKMEC 2), 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. When an individual
has multiple conditions al scoring UKMEC 3 for a method, use of this method may pose an
unacceptable risk clinical judgement should be used in each individual case.
Contraceptive Choice
Many factors determine the method of contraception an individual chooses to use. Provided
the woman is medically eligible to use a particular method, she should be free to choose the
method that is most acceptable to her. To be effective, contraception must be used correctly and
Consistently. Effective and continued use of a method is direct related tots acceptabilty to the
Women should be given accurate information about all methods for which they are medically
eligible and helped to decide which might best sut their needs. Health professionals who give
advice about contraception should be competent to give information about the efficacy, risks
and side effects, advantages and disadvantages, and non-contraceptive benefits of all available
methods,
Information on contraception for women in the UK can be found on the Family Planning
Association (fpa) website +
Effectiveness of Contraceptive Method
Methods that require consistent and correct use by individuals have a wide range of effectiveness
‘and can vary greatly with characteristics such as age, socioeconomic status, users’ desires to
preventor delay pregnancy, and cuture. Table 4 compares the percentage of women experiencing
an unintended pregnancy during the first year of contraceptive use when the method is used
'ypically (which includes both incorrectand inconsistentuse) or perfectly (correctand consistent
use) Methods considered as long-acting reversible contraception (LARC) are highlighted in
Table 4.
Table 4: Percentage of women experiencing an unintended pregnancy within the first
year of use with typical use and perfect use (modified from Trussell et al)
Method
No method.
Ferblty awareness based methods
Female dlaphragm
Male condom 18 2
‘Combined hormenal contraception (CHC) 9 03
Progestogen-oniy pil (POP) 9 03
Progestogen-only injectable (OMPA) é 02
‘Copper-bearing intrauterine device (CuiUD) os 06
Levonorgestrekrelaasing intrauterine system (LNG- Pa =
1s)
Progestogen-only implant (MP) 005 0.05
Female sterisation 05 os
Vasectomy 015 01
“Indudes combined ral contraception (COC), transdermal path pach) and vaginal rings
A pictorial chart on the effectiveness of family planning methods is available from the Centers
for Disease Control and Prevention (CDC) website.”
Drug Interactions with Hormonal Contraception
Use of other medications may increase or decrease serum levels of contraceptive hormones;
likewise, hormonal contraception may increase or decrease serum levels of other medications.
This 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,
For further guidance and resources regarding specific contraceptive methodiformulatio,
please refer to
+ FSRH guidance on drug interactions with hormonal contraception, available on the
FSRH website
+ The British National Formulary (BNF) publications and website *
+ Summary of product characteristics (SPC), available on electronic Medicine Compendium
(eMC) website *
year of use with typical use and perfect use (modified from Trussell et al)
Method
No method.
Ferblty awareness based methods
Female dlaphragm
Male condom 18 2
‘Combined hormenal contraception (CHC) 9 03
Progestogen-oniy pil (POP) 9 03
Progestogen-only injectable (OMPA) é 02
‘Copper-bearing intrauterine device (CuiUD) os 06
Levonorgestrekrelaasing intrauterine system (LNG- Pa =
1s)
Progestogen-only implant (MP) 005 0.05
Female sterisation 05 os
Vasectomy 015 01
“Indudes combined ral contraception (COC), transdermal path pach) and vaginal rings
A pictorial chart on the effectiveness of family planning methods is available from the Centers
for Disease Control and Prevention (CDC) website.”
Drug Interactions with Hormonal Contraception
Use of other medications may increase or decrease serum levels of contraceptive hormones;
likewise, hormonal contraception may increase or decrease serum levels of other medications.
This 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,
For further guidance and resources regarding specific contraceptive methodiformulatio,
please refer to
+ FSRH guidance on drug interactions with hormonal contraception, available on the
FSRH website
+ The British National Formulary (BNF) publications and website *
+ Summary of product characteristics (SPC), available on electronic Medicine Compendium
(eMC) website *
ACTE
Online Drug Interaction Checkers
There are online drug interaction checkers available which give useful information on drug
interactions. For up-to-date information on the potential drug interactions between hormonal
contraception and antiretroviral (ARV) drugs, please refer to the online HIV drugs interaction
checker.”
For up-to-date information on the potential drug interactions between hormonal contraception
and other drugs, please refer to Stockley' Drug Interactions website."
Please note that the contraceptive effectiveness of OMPA and the LNG-IUS isnot reduces by
concurrent use of enzyme-nducing medications.
Afin doubt please refer tothe current FSRH Guideline on Drug Interactions with Hormonal
Contraception.
Conditions that May Pose a Significant Health Risk During Pregnancy
Women with conditions that may pose a significant health risk during pregnancy should be
advised to consider using the most effective LARC methods, which provide a highly reliable
and effective method of contraception (failure rate <1 pregnancy per 100 women in a year).
The sole use of barrier methods and user-dependent methods of contraception (e.g, oral
contraception) may not be the most appropriate choice for these women given thei relatively
higher typical-use failure rates.
‘Some conditions that expose a woman to increased risk as a result of unintended pregnancy
include but are not limited to:
+ Bariatric surgery within the past 2 years
+ Breast cancer
+ Cardiomyopathy
+ Complicated valvular heart disease
+ Cystic fibrosis
+ Diabetes: insulin-dependent, or wth
nephropathyletinopathyineuropathy or
other vascular disease
+ Endometrial or ovarian cancer
+ Epilepsy
+ Gestational trophoblastic neoplasia
+ HiVtelated diseases
+ Hypertension (systolic >160 mmHg or
diastolic >100 mmHg)
Ischaemic heart disease
‘Malignant liver tumours (hepatocellular
carcinoma)
‘Morbid obesity (BMI 240 kg/m’)
Organ fallure/tansplant
Rheumatoid arthritis
Severe (decompensated) cirrhosis
Sickle cell disease
Stoke
‘Systemic lupus erythematosus (SLE)
Systemic sclerosis,
Thrombogenic conditions
Tuberculosis
Teratogenic drugs (ses below)
Online Drug Interaction Checkers
There are online drug interaction checkers available which give useful information on drug
interactions. For up-to-date information on the potential drug interactions between hormonal
contraception and antiretroviral (ARV) drugs, please refer to the online HIV drugs interaction
checker.”
For up-to-date information on the potential drug interactions between hormonal contraception
and other drugs, please refer to Stockley' Drug Interactions website."
Please note that the contraceptive effectiveness of OMPA and the LNG-IUS isnot reduces by
concurrent use of enzyme-nducing medications.
Afin doubt please refer tothe current FSRH Guideline on Drug Interactions with Hormonal
Contraception.
Conditions that May Pose a Significant Health Risk During Pregnancy
Women with conditions that may pose a significant health risk during pregnancy should be
advised to consider using the most effective LARC methods, which provide a highly reliable
and effective method of contraception (failure rate <1 pregnancy per 100 women in a year).
The sole use of barrier methods and user-dependent methods of contraception (e.g, oral
contraception) may not be the most appropriate choice for these women given thei relatively
higher typical-use failure rates.
‘Some conditions that expose a woman to increased risk as a result of unintended pregnancy
include but are not limited to:
+ Bariatric surgery within the past 2 years
+ Breast cancer
+ Cardiomyopathy
+ Complicated valvular heart disease
+ Cystic fibrosis
+ Diabetes: insulin-dependent, or wth
nephropathyletinopathyineuropathy or
other vascular disease
+ Endometrial or ovarian cancer
+ Epilepsy
+ Gestational trophoblastic neoplasia
+ HiVtelated diseases
+ Hypertension (systolic >160 mmHg or
diastolic >100 mmHg)
Ischaemic heart disease
‘Malignant liver tumours (hepatocellular
carcinoma)
‘Morbid obesity (BMI 240 kg/m’)
Organ fallure/tansplant
Rheumatoid arthritis
Severe (decompensated) cirrhosis
Sickle cell disease
Stoke
‘Systemic lupus erythematosus (SLE)
Systemic sclerosis,
Thrombogenic conditions
Tuberculosis
Teratogenic drugs (ses below)
Women using teratogenic drugs (e.g. methotrexate, some anti-epileptic drugs and retinoids)
or drugs with potential teratogenic effects should also be advised to use reliable and effective
contraception both during treatment and forthe recommended timeframe after discontinuation to
avoid unintended pregnancies, More information is available from the UK Teratology Information
‘Service (UKTIS) website.
‘Summary of Changes from UKMEC 2009
A total of 27 topics and more than 126 recommendations were reviewed as part of the UKMEC
revision. Changes from UKMEC 2009 include the exclusion of some methods and conditions,
inclusion of new conditions and ulipristal acetate (UPA) as a new method of EC, removal of
‘spit UKMEC categories, revision of sub-conditions and the reordering of the contraceptive
methods in the UKMEC tables.
Method Sections No Longer Included
‘Comprehensive, method-speciic FSRH guidance on barrier methods for contraception and
‘sexually transmitted infection (STI) prevention", ferity awareness methods [including the
lactational amenorthoea method (LAM)], and male and female sterilisation" is available on
the FSRH website. The GDG considered the sections on these methods in the UKMEC as not
Particularly helpful and so agreed to remove them,
‘Conditions No Longer Included
“The following conditions are no longer included in the UKMEC:
‘Schistosomiasis and malaria: These infectious diseases are uncommon in the UK
population, Evidence suggests no contraindication to hormonal contraception use with both
Conditions (UKMEC 1 forall methods in UKMEC 2009). Please refer to the WHOMEC if
required
Raynaud's disease/phenomenon: Expert opinion from UK theumatologists was that the
UKMEG classification given in the UKMEC 2009 was unhelpfulno longer appropriate since
the risks associated with Raynaud's disease relate to the underlying disease process rather
than the condition itself. Raynaud's disease/phenomenon is therefore no longer included in
the UKMEC.
or drugs with potential teratogenic effects should also be advised to use reliable and effective
contraception both during treatment and forthe recommended timeframe after discontinuation to
avoid unintended pregnancies, More information is available from the UK Teratology Information
‘Service (UKTIS) website.
‘Summary of Changes from UKMEC 2009
A total of 27 topics and more than 126 recommendations were reviewed as part of the UKMEC
revision. Changes from UKMEC 2009 include the exclusion of some methods and conditions,
inclusion of new conditions and ulipristal acetate (UPA) as a new method of EC, removal of
‘spit UKMEC categories, revision of sub-conditions and the reordering of the contraceptive
methods in the UKMEC tables.
Method Sections No Longer Included
‘Comprehensive, method-speciic FSRH guidance on barrier methods for contraception and
‘sexually transmitted infection (STI) prevention", ferity awareness methods [including the
lactational amenorthoea method (LAM)], and male and female sterilisation" is available on
the FSRH website. The GDG considered the sections on these methods in the UKMEC as not
Particularly helpful and so agreed to remove them,
‘Conditions No Longer Included
“The following conditions are no longer included in the UKMEC:
‘Schistosomiasis and malaria: These infectious diseases are uncommon in the UK
population, Evidence suggests no contraindication to hormonal contraception use with both
Conditions (UKMEC 1 forall methods in UKMEC 2009). Please refer to the WHOMEC if
required
Raynaud's disease/phenomenon: Expert opinion from UK theumatologists was that the
UKMEG classification given in the UKMEC 2009 was unhelpfulno longer appropriate since
the risks associated with Raynaud's disease relate to the underlying disease process rather
than the condition itself. Raynaud's disease/phenomenon is therefore no longer included in
the UKMEC.
TER
Drug interactions: Drug interactions are no longer presented at the end of each method
‘section since the recommendations quickly become outdated as new drugs become available.
Where appropriate to a speciie condition (eg. HIV infection or epilepsy), references to the
‘section on drug interactions with hormonal contraception and to relevant online drug interaction
‘checkers are made.
Inclusion of New Conditions
The new conditions added to the UKMEC include history of bariatric surgery, organ transplant,
cardiomyopathy, cardiac arthythmias, theumatoid arthritis, and postive antiphospholipid
antibodies,
The inclusion ofthese conditions into the UKMEC reflects increasing prevalence of women with
these conditions requesting contraception and the need of contraception providers for guidance.
Conditions for which there is a Revision of Sub-condition Description
Conditions where the sub-condtions have been revised include postpartum, gestational
trophoblastic disease, cervical cancer, HIV infection, and SLE.
Revisions to the sub-condition descriptions have been made to provide guidance that is more
‘specific relevant t the sub-population of women with each condition based on new evidence or
development of clinical practicelopinion,
Removal of Split C:
As they were considered unhelpful, split categories (e.g. UKMEC 213 or 3/4) are no longer
used in the UKMEC for the following conditions: multiple risk factors for cardiovascular disease,
known dysiipidaemias, viral hepattis (acute or flare) and diabetes (nephropathy/retinopathy!
‘neuropathy and other vascular disease).
Clarifications have been added or expanded upon to aid clinicians in their judgement regarding
whether a particular method of contraception is safe and appropriate for a woman,
Reordering of the Method Categories Presented in the UKMEC Tables
The order of contraceptive methods presented in the UKMEC has been changed to broadly
reflect (rom leftto right) long-acting, medium-acting and short-acting methods of contraception.
Inclusion of Ulipristal Acetate as New Method of Emergency Contraception
‘The UKMEC now includes ulpristal acetate (UPA) as a method of EC. The order ofthe methods
presentedin the UKMEC table reflects the effectiveness ofthe method (rom lefto right): copper-
bearing IUD (Cu-lUD), UPA and levonorgestrel (LNG),
(Changes to the UKMEC 2008 in the EC section include the addition of obesity as a new condition
(UKMEC 1 for all methods) and the expansion of the sub-conditions and UKMEC classification
recommendations for gestational trophoblastic disease (TD).
o .
Drug interactions: Drug interactions are no longer presented at the end of each method
‘section since the recommendations quickly become outdated as new drugs become available.
Where appropriate to a speciie condition (eg. HIV infection or epilepsy), references to the
‘section on drug interactions with hormonal contraception and to relevant online drug interaction
‘checkers are made.
Inclusion of New Conditions
The new conditions added to the UKMEC include history of bariatric surgery, organ transplant,
cardiomyopathy, cardiac arthythmias, theumatoid arthritis, and postive antiphospholipid
antibodies,
The inclusion ofthese conditions into the UKMEC reflects increasing prevalence of women with
these conditions requesting contraception and the need of contraception providers for guidance.
Conditions for which there is a Revision of Sub-condition Description
Conditions where the sub-condtions have been revised include postpartum, gestational
trophoblastic disease, cervical cancer, HIV infection, and SLE.
Revisions to the sub-condition descriptions have been made to provide guidance that is more
‘specific relevant t the sub-population of women with each condition based on new evidence or
development of clinical practicelopinion,
Removal of Split C:
As they were considered unhelpful, split categories (e.g. UKMEC 213 or 3/4) are no longer
used in the UKMEC for the following conditions: multiple risk factors for cardiovascular disease,
known dysiipidaemias, viral hepattis (acute or flare) and diabetes (nephropathy/retinopathy!
‘neuropathy and other vascular disease).
Clarifications have been added or expanded upon to aid clinicians in their judgement regarding
whether a particular method of contraception is safe and appropriate for a woman,
Reordering of the Method Categories Presented in the UKMEC Tables
The order of contraceptive methods presented in the UKMEC has been changed to broadly
reflect (rom leftto right) long-acting, medium-acting and short-acting methods of contraception.
Inclusion of Ulipristal Acetate as New Method of Emergency Contraception
‘The UKMEC now includes ulpristal acetate (UPA) as a method of EC. The order ofthe methods
presentedin the UKMEC table reflects the effectiveness ofthe method (rom lefto right): copper-
bearing IUD (Cu-lUD), UPA and levonorgestrel (LNG),
(Changes to the UKMEC 2008 in the EC section include the addition of obesity as a new condition
(UKMEC 1 for all methods) and the expansion of the sub-conditions and UKMEC classification
recommendations for gestational trophoblastic disease (TD).
o .
2) Dto <S weeks DES 4
D) 25 weeks to <Bmonis
(primary breastfeeding) Aa e =
925 months Lil 7
2) O10 <S weeks
(0 Win thr isk cor for VTE ser EJ
(Witt erik factors A 3
D) 310 <B weeks
(0 Wh other isk for foe VTE ı 12 JH 3
(tout ana ara DEDO =
ETS EU DK ES 1
2) Oto <4Bhous Ta
D) 48 hours o <a weeks >|»
©) ee ı
+) Posparum sepsis «|<
E aaa Pr
ora MORE He TS SU CN PORO O OS Te
‘ert emos eras ee nce ot o please ora ance
A ts cm sera ao wrt ft
D) 25 weeks to <Bmonis
(primary breastfeeding) Aa e =
925 months Lil 7
2) O10 <S weeks
(0 Win thr isk cor for VTE ser EJ
(Witt erik factors A 3
D) 310 <B weeks
(0 Wh other isk for foe VTE ı 12 JH 3
(tout ana ara DEDO =
ETS EU DK ES 1
2) Oto <4Bhous Ta
D) 48 hours o <a weeks >|»
©) ee ı
+) Posparum sepsis «|<
E aaa Pr
ora MORE He TS SU CN PORO O OS Te
‘ert emos eras ee nce ot o please ora ance
A ts cm sera ao wrt ft
2) With <30 gin EMI AAA 1
D) With 330-34 kg ENT Dima A E
©) With 235 Kom: EM A ee A
2) Complicated: grat faro (acute or
nic.
‘ejection, cardiac alegra vascuopaty
Uncomplicated
CARDIOVASCULAR DISEASE (CVD)
‘Multiple risk factors for carcovascular
disease (such as smoking, diablos. O E O ES a
hypertension, obesty and dyalidaemias)
Known ayaı 712121212 2
myopathy
2) Norma cardiac funcion MT DT EC CT z
D) Impared carla function a we 4
2) All fran
1) Known eng QT syndrome
NEUROLOGICAL CONDITIONS
Idiopathic intracranial hypertension (IH)
Tandon be ators UI DA OS Wa A DO RTH HOOT
Fe D = pore larly SINE e saan oo
{borer ts mos ere mosca poner ands torre Pa cuca pa
Oe ne asco comers ae ero nee sel al
D) With 330-34 kg ENT Dima A E
©) With 235 Kom: EM A ee A
2) Complicated: grat faro (acute or
nic.
‘ejection, cardiac alegra vascuopaty
Uncomplicated
CARDIOVASCULAR DISEASE (CVD)
‘Multiple risk factors for carcovascular
disease (such as smoking, diablos. O E O ES a
hypertension, obesty and dyalidaemias)
Known ayaı 712121212 2
myopathy
2) Norma cardiac funcion MT DT EC CT z
D) Impared carla function a we 4
2) All fran
1) Known eng QT syndrome
NEUROLOGICAL CONDITIONS
Idiopathic intracranial hypertension (IH)
Tandon be ators UI DA OS Wa A DO RTH HOOT
Fe D = pore larly SINE e saan oo
{borer ts mos ere mosca poner ands torre Pa cuca pa
Oe ne asco comers ae ero nee sel al
ıTı ICI EX Ta 1
Tag eens to me Denen
Se
See
nn:
Feroe tematon one penal gratos
between hormonal contraception and ant-epleptic drug
siete rl le one gere chester avale
En Stockley’ interaction Checker webste.”
BREAST AND REPRODUCTIVE TRACT CONDITIONS.
2) Undetedable hCG levels pipi]: 1
D) Decreasing hCG levels A A E 1
©) Pesistertly elevated CG levels or
malignant disease 2 [papa]? L
a) Awating treatment
™ 2|2|+ 2
DIEIEIE)
ARA Ei
Unagnosed massbrest symtoms
OS me ılz[:[|: OS
D) Benign breast conditions E DCI ICI ICI EC 1
©) Famiy history ofbreast cancer E DCI ICI CI B 1
© Carers ofknown gene mutations
associated wih breast cancer (9. ı|2|2]|2]|2 3
BROAIBRCAZ)
©) Breas cancer
(Curent beast cancer ı Ts CI ICI EE] 4
(Past breast cancer CON CI IC AE E
cocos ca
DIAM orson cans ters on st aora aio tac pov sce
Steet minors ely ind ao ser sepa meas a ala ok
Tag eens to me Denen
Se
See
nn:
Feroe tematon one penal gratos
between hormonal contraception and ant-epleptic drug
siete rl le one gere chester avale
En Stockley’ interaction Checker webste.”
BREAST AND REPRODUCTIVE TRACT CONDITIONS.
2) Undetedable hCG levels pipi]: 1
D) Decreasing hCG levels A A E 1
©) Pesistertly elevated CG levels or
malignant disease 2 [papa]? L
a) Awating treatment
™ 2|2|+ 2
DIEIEIE)
ARA Ei
Unagnosed massbrest symtoms
OS me ılz[:[|: OS
D) Benign breast conditions E DCI ICI ICI EC 1
©) Famiy history ofbreast cancer E DCI ICI CI B 1
© Carers ofknown gene mutations
associated wih breast cancer (9. ı|2|2]|2]|2 3
BROAIBRCAZ)
©) Breas cancer
(Curent beast cancer ı Ts CI ICI EE] 4
(Past breast cancer CON CI IC AE E
cocos ca
DIAM orson cans ters on st aora aio tac pov sce
Steet minors ely ind ao ser sepa meas a ala ok
3) Charl infection (ret)
Wsymptomatie Pla Ta Ir 1
Wasymstomatie E EE NE ACT BES EN 1
D Puntentceritsorgonontocataen) | a [2lal2| » | ı |: 1
©) Otereurent secu vane | 2 | 2 | 1 | a |: 2
à Vogts nung Tchomones von oil a | | ow la
and bactral ago (era)
Ines kor Sis
3) High ik of infection Wi A E z
Erz]
(WED count 2200 cam ı 1: E a
(i) DA count 200 cle? pata 1
€ Pine amer ARV dus ean AV ras et pt fect he maby of
1 homenes normal contacto,
For uptodate information on the potential drug interactions
ehe hormenal contraception ng ANY rus peso retro
nine MN drags Iron cect”
ES ae TN UE AS DANNY ANNA De RACER
PE d'en etre moet tinea pene ane Tara su euer are, ence
Sham meses comers ame oral mee sei al
Wsymptomatie Pla Ta Ir 1
Wasymstomatie E EE NE ACT BES EN 1
D Puntentceritsorgonontocataen) | a [2lal2| » | ı |: 1
©) Otereurent secu vane | 2 | 2 | 1 | a |: 2
à Vogts nung Tchomones von oil a | | ow la
and bactral ago (era)
Ines kor Sis
3) High ik of infection Wi A E z
Erz]
(WED count 2200 cam ı 1: E a
(i) DA count 200 cle? pata 1
€ Pine amer ARV dus ean AV ras et pt fect he maby of
1 homenes normal contacto,
For uptodate information on the potential drug interactions
ehe hormenal contraception ng ANY rus peso retro
nine MN drags Iron cect”
ES ae TN UE AS DANNY ANNA De RACER
PE d'en etre moet tinea pene ane Tara su euer are, ence
Sham meses comers ame oral mee sei al
ENDOCRINE CONDITIONS
2) History of gestational disease
D) Nensvascular disease
TU Nor-inauin dependent
(Insur dependent
©) Nephvopathylatinopatyewopathy
4) Other vascular disease
2) fete fre Ea
TT
D) Comer CE CI EU 3 4
©) Gone
RHEUMATIC DISEASES
ei lupus erythematosus (SLE)
2) No anphosphalpid antbodies
1) Postive aniphospholpidantbodies
Positiv ani
DRUG INTERACTIONS,
Taking medication ‘See section on ru interactions wth hormonal convacepton.
TE sy DIE AN RO A NE OST
A rz cr men snr ans coma concen en
EEE EEE
2) History of gestational disease
D) Nensvascular disease
TU Nor-inauin dependent
(Insur dependent
©) Nephvopathylatinopatyewopathy
4) Other vascular disease
2) fete fre Ea
TT
D) Comer CE CI EU 3 4
©) Gone
RHEUMATIC DISEASES
ei lupus erythematosus (SLE)
2) No anphosphalpid antbodies
1) Postive aniphospholpidantbodies
Positiv ani
DRUG INTERACTIONS,
Taking medication ‘See section on ru interactions wth hormonal convacepton.
TE sy DIE AN RO A NE OST
A rz cr men snr ans coma concen en
EEE EEE
ACTE
SECTION B: METHODS OF CONTRACEPTION
Intrauterine Contraception (IUC)
Progestogen-only Contraception (POC),
Combined Hormonal Contraception (CHC).
Emergency Contraception (EC)
Summary Table for Hormonal and Intrauterine Contraception,
62
9
SECTION B: METHODS OF CONTRACEPTION
Intrauterine Contraception (IUC)
Progestogen-only Contraception (POC),
Combined Hormonal Contraception (CHC).
Emergency Contraception (EC)
Summary Table for Hormonal and Intrauterine Contraception,
62
9
INTRAUTERINE CONTRACEPTION (IUC)
Intrauterine contraception (IUC) is highly effective and long-acting. The licensed duration of
use of IUC ranges from 3 to 10 years. IUC is significantly more cost effective than shorter-
‘acting methods due to very low failure rates and requirement for very minimal action by the
user apart from undergoing the initial insertion procedure
UC comprises two types:
+ Copper-bearing intrauterine device (Cu-IUD)
+ Levonorgestrelreleasing intrauterine system (LNG-IUS).
FSRH guidance on IUC! is avaliable on the FSRH website
‘Copper-bearing intrauterine device (CuAUD)
Cu-lUDS have copper on their central stems and may also be banded with copper sleeves on
the arms. The surface area from which copper is released varies between devices. In general,
banded Cu-IUDs which have the higher surface areas of copper are the most effective and
long-lasting so are recommended as the first-choice copper devices.
Levonorgestrel-releasing intrauterine system (LNG-IUS)
‘Several LNG-IUS devices are now available with two dosages of LNG. The 13.5 mg LNG-IUS
(releasing 6 19 LNG/day) is icensed for 3 years and the 52 mg LNG-IUS (releasing 20 yg
LNG/day) for 5 years. Although there are significantly more data for the 52 mg LNG-IUS, the
categories within the UKMEC can be extrapolated to the 13.5 mg LNG-IUS,
Intrauterine contraception (IUC) is highly effective and long-acting. The licensed duration of
use of IUC ranges from 3 to 10 years. IUC is significantly more cost effective than shorter-
‘acting methods due to very low failure rates and requirement for very minimal action by the
user apart from undergoing the initial insertion procedure
UC comprises two types:
+ Copper-bearing intrauterine device (Cu-IUD)
+ Levonorgestrelreleasing intrauterine system (LNG-IUS).
FSRH guidance on IUC! is avaliable on the FSRH website
‘Copper-bearing intrauterine device (CuAUD)
Cu-lUDS have copper on their central stems and may also be banded with copper sleeves on
the arms. The surface area from which copper is released varies between devices. In general,
banded Cu-IUDs which have the higher surface areas of copper are the most effective and
long-lasting so are recommended as the first-choice copper devices.
Levonorgestrel-releasing intrauterine system (LNG-IUS)
‘Several LNG-IUS devices are now available with two dosages of LNG. The 13.5 mg LNG-IUS
(releasing 6 19 LNG/day) is icensed for 3 years and the 52 mg LNG-IUS (releasing 20 yg
LNG/day) for 5 years. Although there are significantly more data for the 52 mg LNG-IUS, the
categories within the UKMEC can be extrapolated to the 13.5 mg LNG-IUS,
Ne
FSRH Rda.
Intrauterine Contraception UC) UC does nat protec against STUMV. thre ik of STIMI
ne {eetudng ng reganc or posar const andconsisent
Lera long US (LIGHUS) of cmtacepion Male condomereaice thea of SN.
CATEGORY CLARIFICATONEVDENCE
Su ada comment at endo (Sinsation,
‘aco contrato
EN
PERSONAL CHARACTERISTICS AND REPRODUCTIVE HISTORY
Pregnancy NA | NA | Clarification: Most pregnancies which occur
in women using UC wil e intrauterino, but
cop pregnancy mustbe excluded.
Women whe become pregnant whilst using
IU shoud be informed ofthe increased
risks of second rimester septic mscaiage,
preterm delivery and infection ithe JC ise
ln tu. Women who ar pregnant wth WC in
‘ky and wah to coninue wäh he pregnancy
Shad be informed that when posable,
TUG removal educes the ik of an adverse
cuteome. However, removal sel caries
3 mal ick ot miscariage. Whether or nat
IU is removed, pregnant women should be
avsedto seek medial care line develop
heavy bleeding. ramping pain, abnormal
vaginal dschatge or fever
2) Menarcheto <20 years 2 2 | Evidence: Risks of pregnancy, ntecion and
perte are ow among INC users of at
Dene a + | ges. Removals fr bleeding issues do not
appear tobe related io age. Younger women
tang UC may have an nereased risk of
expulsion compared wth der women."
2) Natiparous 1 1 | Evidence: Rist or expulsion prorat,
7 4 | pregnanes and inten are iow among at
1) Porous [Uc users and ferences by party may not
be cincaly meaning. Data donot suggest
an increased delay net to fry fr
ruiparus UC users Se
‘anon O DIU DA MS Y RAR DE DENTS
A eta
FSRH Rda.
Intrauterine Contraception UC) UC does nat protec against STUMV. thre ik of STIMI
ne {eetudng ng reganc or posar const andconsisent
Lera long US (LIGHUS) of cmtacepion Male condomereaice thea of SN.
CATEGORY CLARIFICATONEVDENCE
Su ada comment at endo (Sinsation,
‘aco contrato
EN
PERSONAL CHARACTERISTICS AND REPRODUCTIVE HISTORY
Pregnancy NA | NA | Clarification: Most pregnancies which occur
in women using UC wil e intrauterino, but
cop pregnancy mustbe excluded.
Women whe become pregnant whilst using
IU shoud be informed ofthe increased
risks of second rimester septic mscaiage,
preterm delivery and infection ithe JC ise
ln tu. Women who ar pregnant wth WC in
‘ky and wah to coninue wäh he pregnancy
Shad be informed that when posable,
TUG removal educes the ik of an adverse
cuteome. However, removal sel caries
3 mal ick ot miscariage. Whether or nat
IU is removed, pregnant women should be
avsedto seek medial care line develop
heavy bleeding. ramping pain, abnormal
vaginal dschatge or fever
2) Menarcheto <20 years 2 2 | Evidence: Risks of pregnancy, ntecion and
perte are ow among INC users of at
Dene a + | ges. Removals fr bleeding issues do not
appear tobe related io age. Younger women
tang UC may have an nereased risk of
expulsion compared wth der women."
2) Natiparous 1 1 | Evidence: Rist or expulsion prorat,
7 4 | pregnanes and inten are iow among at
1) Porous [Uc users and ferences by party may not
be cincaly meaning. Data donot suggest
an increased delay net to fry fr
ruiparus UC users Se
‘anon O DIU DA MS Y RAR DE DENTS
A eta
Inraere Contraception (UC) UC does not protect against STIHIV here I at of SHV
(ningu pregnancy o postpartum) te caret and consistent
Levonorgestrel leasing US (ING 1U ntraception, Male condoms reduce the risk of STVHIV.
‘CONDITION. CATEGORY ‘CLARIFICATION/EVIDENCE
“See sal coma send of initio.
cn 2 contain
Su | wews
Postpartum (m breastfeeding or non
3) Oto <4Bhours 1 1] Evidence: A systematic review concludes
hatinseion ofan IC win the fest 48
b) 48 hours to <4 weeks 3 2 | hours ef vaginal er caesarean devery is
a 5 1] safe Post placentlinsaio and sation
Between TO minutes and 48 hour afer
delvery esut higher expulsion ates than
Insertion 4-8 weeks pospartum of non
Pospartum inseion Insertion tthe Ime of
eaesarean secon ie associated with over
txpulsion rate than post pscental nseton at
thetime of vaginal debvery™
There are ted data on insertion between
43 hours and weeks Tres cohort
ci ot porto Bi ualty compare
uicomes of pos-placental UD mation
‘tthinsrton bebreen 10 minutes and 72
hours ater delivery The sudes show a vide
range of expulsion rates: one stay repos
an expulsion rate of> 7086"
“Tne rate of urine perforation associated
sith IC use lave) ow Me most important
"sk factors or tene perforation are
Insertion during lactation ad inset inthe
BB weeks ater nung bth
“Tao majarty of studies show no significant
‘ferences reasteeäng cutcomes n
women using {NG-IUS with insertion ether,
immediately postpartum or ater 4 week
© Postpartum sepas 4 4 | Clarification: immediate insertion ofan UC
may substantially worsen the coito,
NOIA an DIE ven ROG una IA me TAT ONT
DE maps aus mol cnc una snr tea sap em pov, ance
Seine mens a soe ma nite neon wen nace ut
(ningu pregnancy o postpartum) te caret and consistent
Levonorgestrel leasing US (ING 1U ntraception, Male condoms reduce the risk of STVHIV.
‘CONDITION. CATEGORY ‘CLARIFICATION/EVIDENCE
“See sal coma send of initio.
cn 2 contain
Su | wews
Postpartum (m breastfeeding or non
3) Oto <4Bhours 1 1] Evidence: A systematic review concludes
hatinseion ofan IC win the fest 48
b) 48 hours to <4 weeks 3 2 | hours ef vaginal er caesarean devery is
a 5 1] safe Post placentlinsaio and sation
Between TO minutes and 48 hour afer
delvery esut higher expulsion ates than
Insertion 4-8 weeks pospartum of non
Pospartum inseion Insertion tthe Ime of
eaesarean secon ie associated with over
txpulsion rate than post pscental nseton at
thetime of vaginal debvery™
There are ted data on insertion between
43 hours and weeks Tres cohort
ci ot porto Bi ualty compare
uicomes of pos-placental UD mation
‘tthinsrton bebreen 10 minutes and 72
hours ater delivery The sudes show a vide
range of expulsion rates: one stay repos
an expulsion rate of> 7086"
“Tne rate of urine perforation associated
sith IC use lave) ow Me most important
"sk factors or tene perforation are
Insertion during lactation ad inset inthe
BB weeks ater nung bth
“Tao majarty of studies show no significant
‘ferences reasteeäng cutcomes n
women using {NG-IUS with insertion ether,
immediately postpartum or ater 4 week
© Postpartum sepas 4 4 | Clarification: immediate insertion ofan UC
may substantially worsen the coito,
NOIA an DIE ven ROG una IA me TAT ONT
DE maps aus mol cnc una snr tea sap em pov, ance
Seine mens a soe ma nite neon wen nace ut
SR
Tuten Cotacepton UC) UE doesn protect aga STA
a (rotate gang à rar cone ot
ains UE UNS) cnica hae condensa al ST
conoman Camcorr CLARFICATONEWOENCE
“se mat Cont tenses | into,
ps cama
EN
2) First vimester 1 | Evidence: 1UC can be inserted immedatay
ater (rt or seconstiester,srgeal or
Pb) Second trimester 2 2 orice
Evidence: Thereis no difrence in sk of
complications for immediate versus delayed
Inserien ofan UC ater aberion. Expulsion
may be greater when an lUCisinseted
{olowing secand imester abortion versus
folowing (a meser aborn =
©) Post abortion sepais 7 + | Clarification: inmedsteinserion of an UC
may substantial worse the code.
1 1
usa often, ana asocia vi
2) Age <35 years 1 1 [une re tye estaa
D) Age 235 years
sal Evidence: COC ver who smote ae atan
WEIS goss 1 1] orense otOVO, aspect compares
sal a 7 vin ora o do nat sek Suds alo how
CEE nina ik oth an cran mbes
i Stopped smoking <1 year 1 1] eregrens emake por doy 23-34
(i Stopped smoking 21 year 1 1
‘The 35 yoo age cut of sidered cause
any excess metal assocledh ons
‘ny apparent fom bis age Tho malty rte
From causes (lang cancer) decreases ©
that of ncnsmeker hin 2 yate smoking
eatin Me crosse nate (CVD)
Serocatedwih amhing deraten win 1105
rs among ces =”
or: POE
— A EE ear
Tuten Cotacepton UC) UE doesn protect aga STA
a (rotate gang à rar cone ot
ains UE UNS) cnica hae condensa al ST
conoman Camcorr CLARFICATONEWOENCE
“se mat Cont tenses | into,
ps cama
EN
2) First vimester 1 | Evidence: 1UC can be inserted immedatay
ater (rt or seconstiester,srgeal or
Pb) Second trimester 2 2 orice
Evidence: Thereis no difrence in sk of
complications for immediate versus delayed
Inserien ofan UC ater aberion. Expulsion
may be greater when an lUCisinseted
{olowing secand imester abortion versus
folowing (a meser aborn =
©) Post abortion sepais 7 + | Clarification: inmedsteinserion of an UC
may substantial worse the code.
1 1
usa often, ana asocia vi
2) Age <35 years 1 1 [une re tye estaa
D) Age 235 years
sal Evidence: COC ver who smote ae atan
WEIS goss 1 1] orense otOVO, aspect compares
sal a 7 vin ora o do nat sek Suds alo how
CEE nina ik oth an cran mbes
i Stopped smoking <1 year 1 1] eregrens emake por doy 23-34
(i Stopped smoking 21 year 1 1
‘The 35 yoo age cut of sidered cause
any excess metal assocledh ons
‘ny apparent fom bis age Tho malty rte
From causes (lang cancer) decreases ©
that of ncnsmeker hin 2 yate smoking
eatin Me crosse nate (CVD)
Serocatedwih amhing deraten win 1105
rs among ces =”
or: POE
— A EE ear
Inraerme Contraception (UC) ‘UC doesnot protect against STH. there is at of STUHV
(ningu pregnancy o postpartum) te caret and consistent
m ‘of contraception Male condoms reduce he ak of SN.
‘CONDITION. CATEGORY ‘CLARIFICATION/EVIDENCE
“See sal coma send of non,
cn 2 contain
Su | wews
—— ==
— +
ee — EE
a HG
nen nn
A eo 2
eier een
3) Uncomplicated 2 | 2 | sata ncuting tenen! efec and
Conracepive faues "=
Mutipl isc actors for CVD uch | 1 2
as smoking, dabetes, hypertension,
besty and dysipidaemias)
NOIA an DIE ven ROG una IA me TAT ONT
MMMM orson cans ters on st aora aio tac pov sce
Seine mens a soe ma nite neon wen nace ut
(ningu pregnancy o postpartum) te caret and consistent
m ‘of contraception Male condoms reduce he ak of SN.
‘CONDITION. CATEGORY ‘CLARIFICATION/EVIDENCE
“See sal coma send of non,
cn 2 contain
Su | wews
—— ==
— +
ee — EE
a HG
nen nn
A eo 2
eier een
3) Uncomplicated 2 | 2 | sata ncuting tenen! efec and
Conracepive faues "=
Mutipl isc actors for CVD uch | 1 2
as smoking, dabetes, hypertension,
besty and dysipidaemias)
NOIA an DIE ven ROG una IA me TAT ONT
MMMM orson cans ters on st aora aio tac pov sce
Seine mens a soe ma nite neon wen nace ut
Neo
FSRH Rda.
Intrauterine Contraception UC) UC does nat protec against STUMI theresa KO STIMV
a ng una psa popu com ang cant
errores US (UN ‘of comacepion Male candems rec thea of SN.
CATEGORY CLARIFICATONEVDENCE
Su ada comment at endo (Sinsation,
‘aco contrato
EN
ES Sain Fossa
En
ee) cots a at
Mes a
een) Sees Meine a
ee,
[et a Vascular sense Includes coronary heart
a,
O EE + erica cirio
eh EEE
Syste 2100 mmHg or 7 7 |“
si com op
Clarification: When current Pie
measurable aná normal
Clarification: LNG-US may e continued
if women develop ischaemicheart disease
while usng the method. inal Judgement
and assessment of pregnancy and her
factors are require.
Stroke [history of cerebrovascular
Known dyslipidaemi Clarincation: Route screening fer these
geneie mutatons is nt cos eecive
Increase level foal cholesterol fon
denaiy ipoproteins (LDL) aná tigcerides,
‘a wel a decreased levels of igh dent
Tpopretains (HDL), are know rik Factors fr
(CVD. Women withnown, severe, gene
lip disorders are at a much Niger etme
Fisk for CVD and may warrant iter cial
consideration,
2 E
— A EE ear
FSRH Rda.
Intrauterine Contraception UC) UC does nat protec against STUMI theresa KO STIMV
a ng una psa popu com ang cant
errores US (UN ‘of comacepion Male candems rec thea of SN.
CATEGORY CLARIFICATONEVDENCE
Su ada comment at endo (Sinsation,
‘aco contrato
EN
ES Sain Fossa
En
ee) cots a at
Mes a
een) Sees Meine a
ee,
[et a Vascular sense Includes coronary heart
a,
O EE + erica cirio
eh EEE
Syste 2100 mmHg or 7 7 |“
si com op
Clarification: When current Pie
measurable aná normal
Clarification: LNG-US may e continued
if women develop ischaemicheart disease
while usng the method. inal Judgement
and assessment of pregnancy and her
factors are require.
Stroke [history of cerebrovascular
Known dyslipidaemi Clarincation: Route screening fer these
geneie mutatons is nt cos eecive
Increase level foal cholesterol fon
denaiy ipoproteins (LDL) aná tigcerides,
‘a wel a decreased levels of igh dent
Tpopretains (HDL), are know rik Factors fr
(CVD. Women withnown, severe, gene
lip disorders are at a much Niger etme
Fisk for CVD and may warrant iter cial
consideration,
2 E
— A EE ear
Inraere Contraception (UC) UC does not protect against STIHIV here I at of SHV
(ningu pregnancy o postpartum) te caret and consistent
ntraception, Male condoms reduce the risk of STVHIV.
‘CONDITION. CATEGORY ‘CLARIFICATION/EVIDENCE
“See sal coma send of initio.
cn 2 contain
Su | wews
Clarification. VTE includes deep vin
"trombosis (DVT) and pumonary embelsm
2) History of VTE 1 2 | (ey otany aetiology.
1) Current VTE (on antcoapua 1
3 Al Evidence: Limited evidence ndeats that
©) Famiy history of VTE inserto ofthe LNGIUS does na pose
= 77] Major bleeding iss in women on long tem
UFrstdegree relative 1 ees
age ers years
(Fist-dagree relative y 1] ctarifications:
age 245 years Major surgery: Includes major lectve
surgery (>20 minutes duration) and ai
© Major surgery Surgery onthe legs, or surgery wich
pa 7 2 | involves prolonged immobiiation of lower
Immobiisaton im
thot proionges 1 + | Minor surgery: includes operations
‘rmepitsaon, lasing <30 minutes eth a shot duration of
anaesthesia (e, aparescopcsetisation or
© Minor surgery without 1 1 :!
ss ci extraction).
9 Immobity (uvlatedto surgen 1 7
9 heschä use biting ess)
1 1
D) Supera venous Inromboss 1 1
{Known thrombogenic mutations 7 2 | Clarification: Rostne sereenngfertnese
(er. act V Leiden protrombin ‘genetic mutation ine est efect, 2
NOIA an DIE ven men una mm me MATTE a ONT
DE dm res mol On per on tea sap em prä una
Seine mens a soe ma nite neon wen nace ut
(ningu pregnancy o postpartum) te caret and consistent
ntraception, Male condoms reduce the risk of STVHIV.
‘CONDITION. CATEGORY ‘CLARIFICATION/EVIDENCE
“See sal coma send of initio.
cn 2 contain
Su | wews
Clarification. VTE includes deep vin
"trombosis (DVT) and pumonary embelsm
2) History of VTE 1 2 | (ey otany aetiology.
1) Current VTE (on antcoapua 1
3 Al Evidence: Limited evidence ndeats that
©) Famiy history of VTE inserto ofthe LNGIUS does na pose
= 77] Major bleeding iss in women on long tem
UFrstdegree relative 1 ees
age ers years
(Fist-dagree relative y 1] ctarifications:
age 245 years Major surgery: Includes major lectve
surgery (>20 minutes duration) and ai
© Major surgery Surgery onthe legs, or surgery wich
pa 7 2 | involves prolonged immobiiation of lower
Immobiisaton im
thot proionges 1 + | Minor surgery: includes operations
‘rmepitsaon, lasing <30 minutes eth a shot duration of
anaesthesia (e, aparescopcsetisation or
© Minor surgery without 1 1 :!
ss ci extraction).
9 Immobity (uvlatedto surgen 1 7
9 heschä use biting ess)
1 1
D) Supera venous Inromboss 1 1
{Known thrombogenic mutations 7 2 | Clarification: Rostne sereenngfertnese
(er. act V Leiden protrombin ‘genetic mutation ine est efect, 2
NOIA an DIE ven men una mm me MATTE a ONT
DE dm res mol On per on tea sap em prä una
Seine mens a soe ma nite neon wen nace ut
Intrauterine Contraception (UC) LC doesnot protect against STIHIV there is risk of STIMV
{including ung pregnancy or postpartum). the caret andeansstent
AR PRE hectares race
roman con CUARPEATONE ONCE
a Sats
= linn
EN
Valvular and congenital
2) Uncomplicated 1 1 — | clarification: Uncomplicated cases can be
Dose, A 3 | considered where: there is) no requirement
forcardiae medication 1) the woman is
asymptomatic and i) a cardoogy review
Isregured annual or les. Hin doubt
iscussion witha specail cardologistis
ases
hypertension, history of subacute
arterial endocartis)
atl heart disease: Occurs when any
tre hear valves are senc andlor
incompetente 9 arte stenosis, mitral
regurgtason,tuspld valve abnormates,
pulmonary stenosis)
Congental hart disease Acc tenais
tial septal defects, atioventicularsepal
¿ete cardompopaty hypertrophic or
ates), coarctation ofthe aorta, complex
transposon ofthe great arteries, Eben’.
anomaly Eisenmenger syndrome, patent
‘ducts aterosus pulmonary atresia
pulmonary steno. tealogy of Fa, ttl
anomalcus pumenary vencus connection,
Troup ari, truncus aterosus,
ventilar septal def
Prophylais agains bactral endocarditis
no longer inated fr women wih aif
hear valves or previous endocars when
Inserting ar removing UC." However, ba.
does ne necessarly mean that there iso
‘ik
or: POE
CU RE EE ear
{including ung pregnancy or postpartum). the caret andeansstent
AR PRE hectares race
roman con CUARPEATONE ONCE
a Sats
= linn
EN
Valvular and congenital
2) Uncomplicated 1 1 — | clarification: Uncomplicated cases can be
Dose, A 3 | considered where: there is) no requirement
forcardiae medication 1) the woman is
asymptomatic and i) a cardoogy review
Isregured annual or les. Hin doubt
iscussion witha specail cardologistis
ases
hypertension, history of subacute
arterial endocartis)
atl heart disease: Occurs when any
tre hear valves are senc andlor
incompetente 9 arte stenosis, mitral
regurgtason,tuspld valve abnormates,
pulmonary stenosis)
Congental hart disease Acc tenais
tial septal defects, atioventicularsepal
¿ete cardompopaty hypertrophic or
ates), coarctation ofthe aorta, complex
transposon ofthe great arteries, Eben’.
anomaly Eisenmenger syndrome, patent
‘ducts aterosus pulmonary atresia
pulmonary steno. tealogy of Fa, ttl
anomalcus pumenary vencus connection,
Troup ari, truncus aterosus,
ventilar septal def
Prophylais agains bactral endocarditis
no longer inated fr women wih aif
hear valves or previous endocars when
Inserting ar removing UC." However, ba.
does ne necessarly mean that there iso
‘ik
or: POE
CU RE EE ear
Intrauterine Contraception (UC) UC does not protect against STHMIV here I at of SHV
{eluting Ang pregnancy o postpartum) te caret and consistent
traception, Male condoms reduce the risk of STVHIV.
‘CONDITION. CATEGORY ‘CLARIFICATION/EVIDENCE
“See sal coma send of
cn 2 contain
Su | wews
Care
myopathy
2) Normal cardiac función 1 7) | ctaificaion A woman who ie nat on cardio
‘medication can be considered as having
normal ara funcion
D) Impares cards funcion 2 2 | Evidence: No direc evidence ass on
the safety of UC among women wih
carom yopathy. Umied ndrec evidence
‘Yom nor-comparave sudes does not
demonstrate any cases of arhythmia or
Infeciveendocardtis in women win cardiac
daease who used ICH“
Clarification: 1UC inserion may induce
cardiac artis in women wth
atom jopathy. The JUC shouldbe tted
In a hospital satin as a vasovagal reaction
presents a patear nh ik cards
2) Arial orten
D) Krown eng GT syndrome
‘lerification: Cervical simulation during the
inserion ofinvauterne methods can cause
à vasovagal reaction adding bradyeara,
eh increases the sk fa are event
In women wth ong QT syndrome. The
AC sould be fed in hospital setting |
‘asovagal reaction presents a parie
igh iso carla events
Tangent ons ven ROG una mm me MAT Orr
DE dm res mol On per on tea sap em prä una
Seine mens a soe ma nite neon wen nace ut
{eluting Ang pregnancy o postpartum) te caret and consistent
traception, Male condoms reduce the risk of STVHIV.
‘CONDITION. CATEGORY ‘CLARIFICATION/EVIDENCE
“See sal coma send of
cn 2 contain
Su | wews
Care
myopathy
2) Normal cardiac función 1 7) | ctaificaion A woman who ie nat on cardio
‘medication can be considered as having
normal ara funcion
D) Impares cards funcion 2 2 | Evidence: No direc evidence ass on
the safety of UC among women wih
carom yopathy. Umied ndrec evidence
‘Yom nor-comparave sudes does not
demonstrate any cases of arhythmia or
Infeciveendocardtis in women win cardiac
daease who used ICH“
Clarification: 1UC inserion may induce
cardiac artis in women wth
atom jopathy. The JUC shouldbe tted
In a hospital satin as a vasovagal reaction
presents a patear nh ik cards
2) Arial orten
D) Krown eng GT syndrome
‘lerification: Cervical simulation during the
inserion ofinvauterne methods can cause
à vasovagal reaction adding bradyeara,
eh increases the sk fa are event
In women wth ong QT syndrome. The
AC sould be fed in hospital setting |
‘asovagal reaction presents a parie
igh iso carla events
Tangent ons ven ROG una mm me MAT Orr
DE dm res mol On per on tea sap em prä una
Seine mens a soe ma nite neon wen nace ut
SR
Intrauterine Contraception (UC) LC doesnot protect against STIHIV here Is risk of STIMV
Ne (ncudng ung reganc or posar. conse andconsiset
errores US (UN ‘of comacepion Male candems rec thea of SN.
CATEGORY CLARIFICATONEVDENCE
Su ada comment at endo (Sinsation,
‘aco contrato
EN
2) Nen-migrainous (mid or 7 1 | ctarcation: Headaches a common
sever) condi affecting women of reproductive
age. There no ented evidence which
1) Mig without ura at any ' 2 | spectcaly considers migraine in women
Ed (Sng an LNGAUS.
©) Moraine wth awa, a any age i 2
PRETO 7 3 Cassiiation depends cn making an
accurate dagnosis ofthose severe
headaches tat are migranous and. in
‘ation. those compleated by aura!
migraine with aur, any age
Ses adatinal resource on diagnosis of
migraines wah or wet aura
Iatopathi intracranial 7 7
hypertension (ik)
Taking ambeplept drugs Cara anıreplegte drugs have the potenaltoaecthebioavalabilty
“toi hormones in homenalcotracepton Adana, hormonal
Contraception may afec the levels o ta ant-eplepte drugs wäh
potential averse eects
For upte date information en the potential dug interactions between
hormonal contraception and anrepleptc drugs, pease efe to the
nine drug mieracion checker avatable on Socdey interaction
Checker webste
DEPRESSIVE DISORDERS.
Depressive disorders ‘Clarification: The iasfcation is based on
data ce women vih selected depressive
sordera. No data are avaliable on bipolar
dsorder postpartum depression.
Tandon be ators UI DA OS Wa A DO RTH HOOT
‘irate mead rt COM ster che tare sponte meh wet me ak
Intrauterine Contraception (UC) LC doesnot protect against STIHIV here Is risk of STIMV
Ne (ncudng ung reganc or posar. conse andconsiset
errores US (UN ‘of comacepion Male candems rec thea of SN.
CATEGORY CLARIFICATONEVDENCE
Su ada comment at endo (Sinsation,
‘aco contrato
EN
2) Nen-migrainous (mid or 7 1 | ctarcation: Headaches a common
sever) condi affecting women of reproductive
age. There no ented evidence which
1) Mig without ura at any ' 2 | spectcaly considers migraine in women
Ed (Sng an LNGAUS.
©) Moraine wth awa, a any age i 2
PRETO 7 3 Cassiiation depends cn making an
accurate dagnosis ofthose severe
headaches tat are migranous and. in
‘ation. those compleated by aura!
migraine with aur, any age
Ses adatinal resource on diagnosis of
migraines wah or wet aura
Iatopathi intracranial 7 7
hypertension (ik)
Taking ambeplept drugs Cara anıreplegte drugs have the potenaltoaecthebioavalabilty
“toi hormones in homenalcotracepton Adana, hormonal
Contraception may afec the levels o ta ant-eplepte drugs wäh
potential averse eects
For upte date information en the potential dug interactions between
hormonal contraception and anrepleptc drugs, pease efe to the
nine drug mieracion checker avatable on Socdey interaction
Checker webste
DEPRESSIVE DISORDERS.
Depressive disorders ‘Clarification: The iasfcation is based on
data ce women vih selected depressive
sordera. No data are avaliable on bipolar
dsorder postpartum depression.
Tandon be ators UI DA OS Wa A DO RTH HOOT
‘irate mead rt COM ster che tare sponte meh wet me ak
Inraerme Contraception (UC) ‘UC doesnot protect against STH. there is at of STUHV
(ningu pregnancy or postpartum), the correct and consisten
Copperbesing U (UD) ‘of candoms is recammende eher ae o wth nate method
noes racepon Mae condoms reduce the sk of SUN,
3) Ireglar patter wäh heavy Clarification: Abnormal mensual Bleeding
bleeding. should ase suspicion fa serious
PTS = nding condo and be vestes
(includes regular and regular Deus
pattems)
Evidence Evidence from sues examining
hetresiment eects ofthe 52 mg LUCIUS
among women with heavy or prolonged
bleeding report no increase in adverse
effects and Inds the 52 mg LNG-US
benef in treating heavy mensiral
bleeding (MB)
‘Unexplained vaginal bleeding Claiication:Ifpregnancy oran undering
(eures for serous condtion) Pathological conden auch as pets
before evaluation maignancy) i suspected, must be
ran and the category ated
sceordingly. Me UC does nat need tobe
removed before evalabon.
Endometriosis" Evidence: 52 mg ING-US use among
‘women wth endometioss decreases
“yamenerrhowa, pele pala and
Feeney
Benign ovarian tumour
Severe dysmenorthoea"
cocos ca
DIAM orson cans ters on st aora aio tac pov sce
Seine mens a soe ma nite neon wen nace ut
(ningu pregnancy or postpartum), the correct and consisten
Copperbesing U (UD) ‘of candoms is recammende eher ae o wth nate method
noes racepon Mae condoms reduce the sk of SUN,
3) Ireglar patter wäh heavy Clarification: Abnormal mensual Bleeding
bleeding. should ase suspicion fa serious
PTS = nding condo and be vestes
(includes regular and regular Deus
pattems)
Evidence Evidence from sues examining
hetresiment eects ofthe 52 mg LUCIUS
among women with heavy or prolonged
bleeding report no increase in adverse
effects and Inds the 52 mg LNG-US
benef in treating heavy mensiral
bleeding (MB)
‘Unexplained vaginal bleeding Claiication:Ifpregnancy oran undering
(eures for serous condtion) Pathological conden auch as pets
before evaluation maignancy) i suspected, must be
ran and the category ated
sceordingly. Me UC does nat need tobe
removed before evalabon.
Endometriosis" Evidence: 52 mg ING-US use among
‘women wth endometioss decreases
“yamenerrhowa, pele pala and
Feeney
Benign ovarian tumour
Severe dysmenorthoea"
cocos ca
DIAM orson cans ters on st aora aio tac pov sce
Seine mens a soe ma nite neon wen nace ut
Vrs
enim
inst STI tere asco STAN
{including ung pregnancy or postpartum). the caret andeansstent
CLARIFICATONEVDENCE
Intrauterine Contraception (UC) I does not protect ag
errores US (UN ‘of comacepion Male candems rec thea of SN.
‘CONDITION CATEGORY
Su ada comment at endo (Sinsation,
‘aco contrato
EN
tational tophobl
Cervical
Cervical
(emp
Cervical
(cro
2) Undetetabe NOS levels 1 1
D) Decreasing CG levels 3 3
©) Perse elevated nCGiovels | 4 ry
of magnant disease
3) Avalng treatment
Clarification: Includes hydatiom mole
(complete and pari) and gestational
trophoblast neoplasa,
Evidence: Limited evidence suggests that
women using an UC at tene evacuaton
fora molar pregnancy are at no greater
Fisk for gestatonal trephoblsti neoplasia
than are women using cher methods of
contraception =
ecropion
intropitheal neoplasia
‘larficaion: Concer exists about the
increased isk of nection and bleeding at
Insertion, The 1UG wilnomaly be removed
atthe time of surgery, but uni then the
woman sa isk of pregnancy.
D) Radial vacheledomy 3 3
‘larfication: insertion of UC shoud be
«conducted in caution in a specials sting
Ge to abnormal anatomy.
yea a HO
Ben mos esse moet tinea ponernos rors y cal cote
ÉTAT AE EEE wala a
enim
inst STI tere asco STAN
{including ung pregnancy or postpartum). the caret andeansstent
CLARIFICATONEVDENCE
Intrauterine Contraception (UC) I does not protect ag
errores US (UN ‘of comacepion Male candems rec thea of SN.
‘CONDITION CATEGORY
Su ada comment at endo (Sinsation,
‘aco contrato
EN
tational tophobl
Cervical
Cervical
(emp
Cervical
(cro
2) Undetetabe NOS levels 1 1
D) Decreasing CG levels 3 3
©) Perse elevated nCGiovels | 4 ry
of magnant disease
3) Avalng treatment
Clarification: Includes hydatiom mole
(complete and pari) and gestational
trophoblast neoplasa,
Evidence: Limited evidence suggests that
women using an UC at tene evacuaton
fora molar pregnancy are at no greater
Fisk for gestatonal trephoblsti neoplasia
than are women using cher methods of
contraception =
ecropion
intropitheal neoplasia
‘larficaion: Concer exists about the
increased isk of nection and bleeding at
Insertion, The 1UG wilnomaly be removed
atthe time of surgery, but uni then the
woman sa isk of pregnancy.
D) Radial vacheledomy 3 3
‘larfication: insertion of UC shoud be
«conducted in caution in a specials sting
Ge to abnormal anatomy.
yea a HO
Ben mos esse moet tinea ponernos rors y cal cote
ÉTAT AE EEE wala a
Inraere Contraception (UC) UC does not protect against STIHIV here I at of SHV
(ningu pregnancy o postpartum) te caret and consistent
ntraception, Male condoms reduce the risk of STVHIV.
‘CONDITION. CATEGORY ‘CLARIFICATION/EVIDENCE
“See sal coma send of
cn 2 contain
Su | wews
3) Undiagnosed massbreast 7 2 | Clarification: Breast cancer is a hemenaly
symptoms Sanatve tumeur, Concems aut
eT 7 7 | progression ofthe disease may be les wth
») Benign breast conditions INGUS than win COC ochigherdose
©) Famiy sory of breast cancer 1 1] Poe.
‘Carers cfinoun gene mutations | 1 2 | Use ofthe LNG:US n women wth breast
Associated wah breast cancer (9 Pnau oer
BROAIIBRCAZ) be considered on an individual bassin
©) Breast cancer onauitaon wah Ihe woman s encolegy
() Curent breast cancer 1 4
(ipPast breast cancer 1
“l2|4l2
o 1 1
a) Wht sorton ofthe terne cay | 1 1 | Evidence: Among women wih eine
{reds evidence shows no adverse heath
‘events wih 52 mg LNG-US use anda
decrease in symptoms and size of foi
Most women experience improvementsin
serum levels ofnaemoglon,haematoert,
{een and menstrual bod oes"
NOIA an DIE ven ROG una IA me TAT ONT
DE maps aus mol cnc una snr tea sap em pov, ance
Seine mens a soe ma nite neon wen nace ut
(ningu pregnancy o postpartum) te caret and consistent
ntraception, Male condoms reduce the risk of STVHIV.
‘CONDITION. CATEGORY ‘CLARIFICATION/EVIDENCE
“See sal coma send of
cn 2 contain
Su | wews
3) Undiagnosed massbreast 7 2 | Clarification: Breast cancer is a hemenaly
symptoms Sanatve tumeur, Concems aut
eT 7 7 | progression ofthe disease may be les wth
») Benign breast conditions INGUS than win COC ochigherdose
©) Famiy sory of breast cancer 1 1] Poe.
‘Carers cfinoun gene mutations | 1 2 | Use ofthe LNG:US n women wth breast
Associated wah breast cancer (9 Pnau oer
BROAIIBRCAZ) be considered on an individual bassin
©) Breast cancer onauitaon wah Ihe woman s encolegy
() Curent breast cancer 1 4
(ipPast breast cancer 1
“l2|4l2
o 1 1
a) Wht sorton ofthe terne cay | 1 1 | Evidence: Among women wih eine
{reds evidence shows no adverse heath
‘events wih 52 mg LNG-US use anda
decrease in symptoms and size of foi
Most women experience improvementsin
serum levels ofnaemoglon,haematoert,
{een and menstrual bod oes"
NOIA an DIE ven ROG una IA me TAT ONT
DE maps aus mol cnc una snr tea sap em pov, ance
Seine mens a soe ma nite neon wen nace ut
SR
Intrauterine Contraception (UC)
UC does not protect against STINK there is asco SHAN
ne {green x paper casa and coset
easing US UN ‘of comacepion Male condoms rec thea of SN.
‘CONDITION CATEGORY
Su ada comment at endo (Sinsation,
‘aco contrato
EN
CLARIFICATONEVDENCE
Anatomical ab
o) With distortion ofthe tene cavty | 3 3
Clarification: in women wih a dates
tin ev may be appropriate to
tempt nserion of UG ater des.
Evidence: Avalable studies show that ates
e152mg LNGAUS expulsion are higher a
‘women wth uterine foi than in women
witout feroids; however these ndngs
are ether not tabsticaly significant or
Significance testng was not conducted
"Rates of expulsion fom nor-comparative
studies ranged fom 0% 10 204.
2) Distoes terne cay 3 3
Clarification: Includes any congenital x
acqured nenne abnormal toting
the urine ca in a manner thats
Ieompate with UC inserto,
In some women vi a dstrted uterine
Say may be appropriate to attempt
Insertion of UG ater discussion.
1) Other abnomalies 2 2
Clarification: Includes cerca stenosis or
‘cerca lacerations nt distorting the teme
avy or interfering with IUC insertion,
Tandon be ators UI DA OS Wa A DO RTH HOOT
‘irate ma rt econmenara ns une A menos ae Nt tae ak
Intrauterine Contraception (UC)
UC does not protect against STINK there is asco SHAN
ne {green x paper casa and coset
easing US UN ‘of comacepion Male condoms rec thea of SN.
‘CONDITION CATEGORY
Su ada comment at endo (Sinsation,
‘aco contrato
EN
CLARIFICATONEVDENCE
Anatomical ab
o) With distortion ofthe tene cavty | 3 3
Clarification: in women wih a dates
tin ev may be appropriate to
tempt nserion of UG ater des.
Evidence: Avalable studies show that ates
e152mg LNGAUS expulsion are higher a
‘women wth uterine foi than in women
witout feroids; however these ndngs
are ether not tabsticaly significant or
Significance testng was not conducted
"Rates of expulsion fom nor-comparative
studies ranged fom 0% 10 204.
2) Distoes terne cay 3 3
Clarification: Includes any congenital x
acqured nenne abnormal toting
the urine ca in a manner thats
Ieompate with UC inserto,
In some women vi a dstrted uterine
Say may be appropriate to attempt
Insertion of UG ater discussion.
1) Other abnomalies 2 2
Clarification: Includes cerca stenosis or
‘cerca lacerations nt distorting the teme
avy or interfering with IUC insertion,
Tandon be ators UI DA OS Wa A DO RTH HOOT
‘irate ma rt econmenara ns une A menos ae Nt tae ak
Inraere Contraception (UC) UC does not protect against STIHIV here I at of SHV
(ningu pregnancy o postpartum) te caret and consistent
ntraception, Male condoms reduce the risk of STVHIV.
‘CONDITION. CATEGORY ‘CLARIFICATION/EVIDENCE
“See sal coma send of
cn 2 contain
Su | wews
(10)
3) PID (assuming o current risk 1 1 | Clarification:
{acters for STÍS) Initiation: For ovine UC ination.
"women wth symptomatic poli nfeion
a ‘should be tested for and treated. insertion
2 | shouldbe delayed unt symptoms have
Festes. Appropriate provision of alternative
Contraception shouldbe provided uri he
TUG canbe inserted
Continuation: Fer wemen weh symptomatic
pele infection, eat using appropriate
ntti and perform testing fr STIs.
‘Theres usualy no need to remove the UC
ifthe woman wines continue use
Caninuad use ofan IUC depends onthe
‘woman's informed choice and her current
ik factors for ST and PID. Among IC.
Users treated fer PID. there sno dference in
nica course ithe LUC ie removed or let in|
Fer
NOIA an DIE ven men una mm me MATTE a ONT
DE dm res mol On per on tea sap em prä una
Seine mens a soe ma nite neon wen nace ut
(ningu pregnancy o postpartum) te caret and consistent
ntraception, Male condoms reduce the risk of STVHIV.
‘CONDITION. CATEGORY ‘CLARIFICATION/EVIDENCE
“See sal coma send of
cn 2 contain
Su | wews
(10)
3) PID (assuming o current risk 1 1 | Clarification:
{acters for STÍS) Initiation: For ovine UC ination.
"women wth symptomatic poli nfeion
a ‘should be tested for and treated. insertion
2 | shouldbe delayed unt symptoms have
Festes. Appropriate provision of alternative
Contraception shouldbe provided uri he
TUG canbe inserted
Continuation: Fer wemen weh symptomatic
pele infection, eat using appropriate
ntti and perform testing fr STIs.
‘Theres usualy no need to remove the UC
ifthe woman wines continue use
Caninuad use ofan IUC depends onthe
‘woman's informed choice and her current
ik factors for ST and PID. Among IC.
Users treated fer PID. there sno dference in
nica course ithe LUC ie removed or let in|
Fer
NOIA an DIE ven men una mm me MATTE a ONT
DE dm res mol On per on tea sap em prä una
Seine mens a soe ma nite neon wen nace ut
SR
rere Contacepon (US) ako STAY
a Vegan gang pour). cone ot
Frames Le one pen ase om rs he STN
conoman Camcorr CLARFICATONEWOENCE
“se mat Cont tenses | into,
ps common
EN
(larincation or amy dia: n a woman
vt asymptomatic infectenn an emergency
‘Stuaton (Le. EC). the LG canbe inserted
‘witout delay on the same day as treatment
3) Chiamydal infection (eurent)
(Symptomatic 4 [2 | 4 | 2 [ist
Asymptomatic 2 | 2 | 3 | 2 | cirfeation for initiation: Serening for
3 Puruentcendetis orgonorhoea | 4 | 2 | 4 | 2 | STisinadvanceofinserton (when indeated
(cuen e requested) wil allow infection o be tested
Before inserte rest are unavalable
©) Other euren STis(exehdng HIV | 2 2 | before insertion tien prophylactic antes
and hepatitis) shouldbe considered for women at higher
(ik of STI atime of sation, Me abate
©) Vaginiisncuding Trehomonas | 2 2
vaginale and bacteral vagos) regimen chosen should cover Chlamyaa,
as trechomate,
Clarification for continuation: Treat the STI
Using apprepate abies. The WC usually
does na need tobe removed fine woman
Wishes to coninue using Continued use
(fan UC depends onthe wemas informed
‘choice an her eurent ak factors fr STIs
and PID"
Evidence: There eno evidence whether
IUC insertion among women uno contra
Tis increases ne ik fer PID over at of
women wi no 1UC inserion Among women
ho have UC inserted, Ihe abshue ik or
“ubsequent PID slow among wermen wth an
STi he time ofinaerion but greater than
among wemen wth no ST atthe ime of UC
eee
or: POE
CU RE EE ear
rere Contacepon (US) ako STAY
a Vegan gang pour). cone ot
Frames Le one pen ase om rs he STN
conoman Camcorr CLARFICATONEWOENCE
“se mat Cont tenses | into,
ps common
EN
(larincation or amy dia: n a woman
vt asymptomatic infectenn an emergency
‘Stuaton (Le. EC). the LG canbe inserted
‘witout delay on the same day as treatment
3) Chiamydal infection (eurent)
(Symptomatic 4 [2 | 4 | 2 [ist
Asymptomatic 2 | 2 | 3 | 2 | cirfeation for initiation: Serening for
3 Puruentcendetis orgonorhoea | 4 | 2 | 4 | 2 | STisinadvanceofinserton (when indeated
(cuen e requested) wil allow infection o be tested
Before inserte rest are unavalable
©) Other euren STis(exehdng HIV | 2 2 | before insertion tien prophylactic antes
and hepatitis) shouldbe considered for women at higher
(ik of STI atime of sation, Me abate
©) Vaginiisncuding Trehomonas | 2 2
vaginale and bacteral vagos) regimen chosen should cover Chlamyaa,
as trechomate,
Clarification for continuation: Treat the STI
Using apprepate abies. The WC usually
does na need tobe removed fine woman
Wishes to coninue using Continued use
(fan UC depends onthe wemas informed
‘choice an her eurent ak factors fr STIs
and PID"
Evidence: There eno evidence whether
IUC insertion among women uno contra
Tis increases ne ik fer PID over at of
women wi no 1UC inserion Among women
ho have UC inserted, Ihe abshue ik or
“ubsequent PID slow among wermen wth an
STi he time ofinaerion but greater than
among wemen wth no ST atthe ime of UC
eee
or: POE
CU RE EE ear
Intrauterine Contraception (UC) UC does not protect against STHMIV here I at of SHV
{eluting Ang pregnancy o postpartum) te caret and consistent
traception, Male condoms reduce the risk of STVHIV.
‘CONDITION. CATEGORY ‘CLARIFICATION/EVIDENCE
“See sal coma send of initio.
cn 2 contain
Su | wews
+) Increased isk for STIS 2 2 | Claiication:1UC insertion may father
increase the risk ofPID ameng women at
increased ik of STi, although mie
dente suggests that this ik is low. Rick
of STi ares by invidual behaviour and
local ST prevalence, Therefere, vn many
‘women st neeased risk of STs can have
¡UC inserted, some women at very high sk
of ST may be adised to wal appropriate
{esting and veatment oes
Evidence: One small study shows alow
incidence of PID ater UI sation (22%)
ina coher of women considered tobe
high isk” Another tud reports that
1% of wamen classed as at high STi
experienced JC seed completions
compared wth 5% of those not classe as
oe
3) High ia of HIV infection 1 1 [eine Havane evidence mm one
randomized contaled Wal med no
dla dute dices HN
cuen betwen: DMPA veros CutdD,
DuPAIN versus UNG moin and GAL
asus UNG lat. OF Be loto madero.
at once fom 14 coran ates
sra sucios suggested poseo noted
faker I win progesogu cn cal ue,
hich wat mas tka)” ie 10 unmeasured
‘ound, Lowquay eence fom 3
‘hue! wuerde “no suggen an
tone HIV ek or eplnt ur No suds
‘St sut quly were deis fr POP or
again
Tearaton ann NE poe a vay AN SNS eto pos Te
Serenata ars tones ge eerie Sc Coban ra snk
{eluting Ang pregnancy o postpartum) te caret and consistent
traception, Male condoms reduce the risk of STVHIV.
‘CONDITION. CATEGORY ‘CLARIFICATION/EVIDENCE
“See sal coma send of initio.
cn 2 contain
Su | wews
+) Increased isk for STIS 2 2 | Claiication:1UC insertion may father
increase the risk ofPID ameng women at
increased ik of STi, although mie
dente suggests that this ik is low. Rick
of STi ares by invidual behaviour and
local ST prevalence, Therefere, vn many
‘women st neeased risk of STs can have
¡UC inserted, some women at very high sk
of ST may be adised to wal appropriate
{esting and veatment oes
Evidence: One small study shows alow
incidence of PID ater UI sation (22%)
ina coher of women considered tobe
high isk” Another tud reports that
1% of wamen classed as at high STi
experienced JC seed completions
compared wth 5% of those not classe as
oe
3) High ia of HIV infection 1 1 [eine Havane evidence mm one
randomized contaled Wal med no
dla dute dices HN
cuen betwen: DMPA veros CutdD,
DuPAIN versus UNG moin and GAL
asus UNG lat. OF Be loto madero.
at once fom 14 coran ates
sra sucios suggested poseo noted
faker I win progesogu cn cal ue,
hich wat mas tka)” ie 10 unmeasured
‘ound, Lowquay eence fom 3
‘hue! wuerde “no suggen an
tone HIV ek or eplnt ur No suds
‘St sut quly were deis fr POP or
again
Tearaton ann NE poe a vay AN SNS eto pos Te
Serenata ars tones ge eerie Sc Coban ra snk
SR
Intrauterine Contraception (UC) LC doesnot protect against STII. there ak of STH
ne {green x paper casa and coset
Fan ils SN ‘of conacepion Male condoms rece thea of SN.
‘CONDITION CATEGORY CLARIFICATONEVDENCE
Su ada comment at endo (Sinsation,
‘aco contrato
uw | mens,
D) Hess
(0) D4 cout 2200 cata
(9) C4 cout <200 cam
Clarification: The ination of an UC method
may be appropriate some women th ow
CDA counts wha have an undetectable wal
toad
Evidence: Among UC users ted
evidence shows no increased tsk of
Infection er overall complications when
Comparing Hivinfected wth noninfected
‘women, IUC use snot ound to adversely
afect progression of HIV when compared
to hormonal convacepton use among
Hivinfected women. IUC use among HI
Infected women snot associated with
increased ik of transmission to sexual
parners"""Nodiference is found in
[antiretroviral therapy ination CD4 count
Between users aná nonusers ofthe LNG.
ws
©) Taking antiretroviral (ARV) drugs | Certain ARV drugs have the ptentalto ae the bicavalaity of
steroid hormones in hormonal contracegton
For uptodate information on the potent drug interactions between
Ihomonaleontacepten and ARV drugs, please refer tothe nine HIV
drugs iteración checker”
ee SEE
2) Non-pebe 1 1
D) Pete EEE
eon? Ey
AAA AS
Intrauterine Contraception (UC) LC doesnot protect against STII. there ak of STH
ne {green x paper casa and coset
Fan ils SN ‘of conacepion Male condoms rece thea of SN.
‘CONDITION CATEGORY CLARIFICATONEVDENCE
Su ada comment at endo (Sinsation,
‘aco contrato
uw | mens,
D) Hess
(0) D4 cout 2200 cata
(9) C4 cout <200 cam
Clarification: The ination of an UC method
may be appropriate some women th ow
CDA counts wha have an undetectable wal
toad
Evidence: Among UC users ted
evidence shows no increased tsk of
Infection er overall complications when
Comparing Hivinfected wth noninfected
‘women, IUC use snot ound to adversely
afect progression of HIV when compared
to hormonal convacepton use among
Hivinfected women. IUC use among HI
Infected women snot associated with
increased ik of transmission to sexual
parners"""Nodiference is found in
[antiretroviral therapy ination CD4 count
Between users aná nonusers ofthe LNG.
ws
©) Taking antiretroviral (ARV) drugs | Certain ARV drugs have the ptentalto ae the bicavalaity of
steroid hormones in hormonal contracegton
For uptodate information on the potent drug interactions between
Ihomonaleontacepten and ARV drugs, please refer tothe nine HIV
drugs iteración checker”
ee SEE
2) Non-pebe 1 1
D) Pete EEE
eon? Ey
AAA AS
Inraere Contraception (UC) UC does not protect against STIHIV here I at of SHV
une doc aig regan apostate come ang ote
noes racepon Mae condoms reduce the sk of SUN,
a) History of gestational disease 7 E
D) Nonvascuar disease Evidence: Limited evidence onthe use of
{he LNG-IUS among women sth nu
Nerina dependen 1 [2 | Spender enon opener dones
(Wine dependent 1 2 | suggests that hese methods have ite
‘ect on shot long dem diabetes contra
(69. slycosated haemoglobin levels),
haemastatie markers pi prof. 0
©) Nepheopathyietinopathy! 1 2
neuropathy
©) Other vascular disease 1 2
2) Simple gore 1 1
DE 1 1
Hp 1 7
Gallbladder disease
2) Symptomatic
(Treated by choleysectomy 7 2
(WMedicaty restes 1 2
Mn Cure 1 2
D) Asmptomate 1 2
2 E
Drama em rotores wo cnc pea gr ali enc Ne
ia minors ely ind ao ser sepa MANGA a ala ok
une doc aig regan apostate come ang ote
noes racepon Mae condoms reduce the sk of SUN,
a) History of gestational disease 7 E
D) Nonvascuar disease Evidence: Limited evidence onthe use of
{he LNG-IUS among women sth nu
Nerina dependen 1 [2 | Spender enon opener dones
(Wine dependent 1 2 | suggests that hese methods have ite
‘ect on shot long dem diabetes contra
(69. slycosated haemoglobin levels),
haemastatie markers pi prof. 0
©) Nepheopathyietinopathy! 1 2
neuropathy
©) Other vascular disease 1 2
2) Simple gore 1 1
DE 1 1
Hp 1 7
Gallbladder disease
2) Symptomatic
(Treated by choleysectomy 7 2
(WMedicaty restes 1 2
Mn Cure 1 2
D) Asmptomate 1 2
2 E
Drama em rotores wo cnc pea gr ali enc Ne
ia minors ely ind ao ser sepa MANGA a ala ok
Intrauterine Contraception (UC) LC doesnot protect against STIHIV there is risk of STIMV
{including ung pregnancy or postpartum). the caret andeansstent
m a er
BE. | GER
= SEE,
Tue
DE +
CES 5
ER Tr
Er A
DE dl
as A E
O +
Fu
wo? arcada
MMI nn most meu piper más Teno enc cotas por, nce
Oe ne asco comers ae ero nee sel al
{including ung pregnancy or postpartum). the caret andeansstent
m a er
BE. | GER
= SEE,
Tue
DE +
CES 5
ER Tr
Er A
DE dl
as A E
O +
Fu
wo? arcada
MMI nn most meu piper más Teno enc cotas por, nce
Oe ne asco comers ae ero nee sel al
Inraerme Contraception (UC) ‘UC doesnot protect against STH. there is at of STUHV
(ningu pregnancy or postpartum), the correct and consisten
ree,
cinco
aus | won
CN BR
E
nico Pol wih SLE ea
freon omnes Sess,
EE NE VTE ana siren ine
D) Posie amos 7
E= ‘ial evens stes at many
Le stb cane ande
soos cannes mos cha
cs ir ps
Pr
Positive antiphosphalpid Clariiatio: Postive aniphospholp
anibodes antbodies (PL) ol Alla disease state
fndin the absence of manifestations of the
antphosphegid syndrome astaiteation
ik wth specialist aduce necessary
is recommended. In artcular persistence
of aPLpostvy, high tre of aPL lupus
anticoagulant (LA) post. tipo postivty
er antardciinantbodes (aC), an
Bo-lycopoten!(BgP) and LA aná
‘mmunegicbuin G (190) aPL have greater
ri for ture events"
Taking medication ‘See section an drug interactions with hormonal contrceptn,
cocos ca
DIAM orson cans ters on st aora aio tac pov sce
Seine mens a soe ma nite neon wen nace ut
(ningu pregnancy or postpartum), the correct and consisten
ree,
cinco
aus | won
CN BR
E
nico Pol wih SLE ea
freon omnes Sess,
EE NE VTE ana siren ine
D) Posie amos 7
E= ‘ial evens stes at many
Le stb cane ande
soos cannes mos cha
cs ir ps
Pr
Positive antiphosphalpid Clariiatio: Postive aniphospholp
anibodes antbodies (PL) ol Alla disease state
fndin the absence of manifestations of the
antphosphegid syndrome astaiteation
ik wth specialist aduce necessary
is recommended. In artcular persistence
of aPLpostvy, high tre of aPL lupus
anticoagulant (LA) post. tipo postivty
er antardciinantbodes (aC), an
Bo-lycopoten!(BgP) and LA aná
‘mmunegicbuin G (190) aPL have greater
ri for ture events"
Taking medication ‘See section an drug interactions with hormonal contrceptn,
cocos ca
DIAM orson cans ters on st aora aio tac pov sce
Seine mens a soe ma nite neon wen nace ut
TER
Additional Comments
HYPERTENSION, CURRENT AND HISTORY OF ISCHAEMIC HEART DISEASE, STROKE
There is theoretical concern about the effect of LNG on lipids. There is no restiction for Cu-
wo.
VENOUS THROMBOEMBOLISM (VTE)
The LNG-IUS may be a useful treatment for HMB in women on long-term anticoagulation
therapy.
VAGINAL BLEEDING PATTERNS
LNG-IUS use frequently causes changes in menstrual bleeding patterns. Over time, LNG-IUS.
users are more likely than non-users to become amenorthoeic particularly if they have a 52
mg LNG-IUS fited. 52mg LNG-IUS are used as a treatment for HMB.
ENDOMETRIOSIS
CCu-IUD use may worsen dysmenorthoea associated with the condition
‘SEVERE DYSMENORRHOEA
‘Dysmenorthoea may intensify with Cu-IUD use. LNG-IUS use has been associated with
reduction of dysmenorthoea,
GESTATIONAL TROPHOBLASTIC DISEASE (STD)
There is theoretical concern about increased risk of perforation in Ihe presence of persistent
molar tissue,
CERVICAL INTRAEPITHELIAL NEOPLASIA (CIN)
There is some theoretical concern that progestogens may enhance progression of CIN.
CERVICAL CANCER
Awaiting treatment: There is concern about the increased risk of infection and bleeding at
insertion, The IUC may need to be removed at the time of treatment but, until then, the woman
is at risk of pregnancy.
ENDOMETRIAL CANCER
There is concern about the increased risk of infection, perforation and bleeding at insertion
Additional Comments
HYPERTENSION, CURRENT AND HISTORY OF ISCHAEMIC HEART DISEASE, STROKE
There is theoretical concern about the effect of LNG on lipids. There is no restiction for Cu-
wo.
VENOUS THROMBOEMBOLISM (VTE)
The LNG-IUS may be a useful treatment for HMB in women on long-term anticoagulation
therapy.
VAGINAL BLEEDING PATTERNS
LNG-IUS use frequently causes changes in menstrual bleeding patterns. Over time, LNG-IUS.
users are more likely than non-users to become amenorthoeic particularly if they have a 52
mg LNG-IUS fited. 52mg LNG-IUS are used as a treatment for HMB.
ENDOMETRIOSIS
CCu-IUD use may worsen dysmenorthoea associated with the condition
‘SEVERE DYSMENORRHOEA
‘Dysmenorthoea may intensify with Cu-IUD use. LNG-IUS use has been associated with
reduction of dysmenorthoea,
GESTATIONAL TROPHOBLASTIC DISEASE (STD)
There is theoretical concern about increased risk of perforation in Ihe presence of persistent
molar tissue,
CERVICAL INTRAEPITHELIAL NEOPLASIA (CIN)
There is some theoretical concern that progestogens may enhance progression of CIN.
CERVICAL CANCER
Awaiting treatment: There is concern about the increased risk of infection and bleeding at
insertion, The IUC may need to be removed at the time of treatment but, until then, the woman
is at risk of pregnancy.
ENDOMETRIAL CANCER
There is concern about the increased risk of infection, perforation and bleeding at insertion
‘The IUC may need to be removed at the time of treatment but, until then, the woman is at risk
of pregnancy.
‘OVARIAN CANCER
‘The IUD may need to be removed at the time of treatment but, until then, the woman is at risk
of pregnancy.
HIV INFECTION
Women with HIV infection often have co-morbidties that may influence their choice of
contraception.
‘TUBERCULOSIS
Pelvic: Insertion of an IUC may substantially worsen the condition.
VIRAL HEPATITIS AND CIRRHOSIS
POC are metabolised by the liver and their use may adversely affect women whose liver
function is compromised.
LIVER TUMOURS,
POC are metabolised by the liver and their use may adversely affect women whose liver
function is compromised, No evidence is available regarding hormonal contraceptive use in
‘women with hepatocellular adenoma. COC use is associated with growth of hepatocellular
‘adenoma, but its still unknown whether other hormonal contraceptives have similar effects.
INFLAMMATORY BOWEL DISEASE (IBD)
Risk of VTE may increase in women who are unwell, bed-bound or undergoing emergency or
major surgery and prolonged immobilisation. Under these circumstances the use of the Cu
UD or LNG-IUS is safe.
THALASSAEMIA, SICKLE CELL DISEASE, IRON-DEFICIENCY ANAEMIA
‘There is concern about an increased risk of blood loss with Cu-IUD. However, LNG-IUS is.
‘generally associated with reduced blood los.
of pregnancy.
‘OVARIAN CANCER
‘The IUD may need to be removed at the time of treatment but, until then, the woman is at risk
of pregnancy.
HIV INFECTION
Women with HIV infection often have co-morbidties that may influence their choice of
contraception.
‘TUBERCULOSIS
Pelvic: Insertion of an IUC may substantially worsen the condition.
VIRAL HEPATITIS AND CIRRHOSIS
POC are metabolised by the liver and their use may adversely affect women whose liver
function is compromised.
LIVER TUMOURS,
POC are metabolised by the liver and their use may adversely affect women whose liver
function is compromised, No evidence is available regarding hormonal contraceptive use in
‘women with hepatocellular adenoma. COC use is associated with growth of hepatocellular
‘adenoma, but its still unknown whether other hormonal contraceptives have similar effects.
INFLAMMATORY BOWEL DISEASE (IBD)
Risk of VTE may increase in women who are unwell, bed-bound or undergoing emergency or
major surgery and prolonged immobilisation. Under these circumstances the use of the Cu
UD or LNG-IUS is safe.
THALASSAEMIA, SICKLE CELL DISEASE, IRON-DEFICIENCY ANAEMIA
‘There is concern about an increased risk of blood loss with Cu-IUD. However, LNG-IUS is.
‘generally associated with reduced blood los.
TER
Progestogen-only Contraception (POC)
The section on progestogen-only contraception (POC) includes the following methods:
+ Progestogen-only implant (IMP)
+ Progestogen-only injectable: depot medroxyprogesterone acetate (DMPA)
+ Progestogen-only pil (POP)
FSRH guidance on the IP. progestogen-only injectable? and POP? is available on the FSRH
website.
Progestogen-only implant (IMP)
he recommendations in the UKMEC refer t the single-rod implant containing 68 mg
úetonogestrel licensed for 3 years of use in the UK. For women using LNG implants the
UKMEG categories are considered the same as for etonogestrel implants,
Progestogen-only injectables: depot medroxyprogesterone acetate (DMPA)
‘The recommendations in the UKMEC refer to DMPA given intramuscularly (IM) or
‘subcutaneously (SC) at 13-weekiy intervals =
The available evidence reviewed by the UKMEC GDG suggests that DMPA-SC and DMPA-
IM appear to be therapeutically equivalent with similar safety profiles when used by healthy
women, The GDG considers the evidence availabe for DMPA-IM to be applicable to
DMPA-SC and, therefore, DMPA-SC should have the same categories as DMPA-IM This
is presented in the UKMEO tables as the method ‘DMPA. For women using intramuscular
notethisterone enantate (NET-EN), which is not licensed in the UK for long-term
contraception, the UKMEC categories are considered the same as for DMPA
here are theoretical concerns that higher doses of progestogen in injectables and longer
duration of action may be associated with increased risk compared to IMP and POP in some
Conditions. The higher UKMEC classifications reflect this.
a u
Progestogen-only Contraception (POC)
The section on progestogen-only contraception (POC) includes the following methods:
+ Progestogen-only implant (IMP)
+ Progestogen-only injectable: depot medroxyprogesterone acetate (DMPA)
+ Progestogen-only pil (POP)
FSRH guidance on the IP. progestogen-only injectable? and POP? is available on the FSRH
website.
Progestogen-only implant (IMP)
he recommendations in the UKMEC refer t the single-rod implant containing 68 mg
úetonogestrel licensed for 3 years of use in the UK. For women using LNG implants the
UKMEG categories are considered the same as for etonogestrel implants,
Progestogen-only injectables: depot medroxyprogesterone acetate (DMPA)
‘The recommendations in the UKMEC refer to DMPA given intramuscularly (IM) or
‘subcutaneously (SC) at 13-weekiy intervals =
The available evidence reviewed by the UKMEC GDG suggests that DMPA-SC and DMPA-
IM appear to be therapeutically equivalent with similar safety profiles when used by healthy
women, The GDG considers the evidence availabe for DMPA-IM to be applicable to
DMPA-SC and, therefore, DMPA-SC should have the same categories as DMPA-IM This
is presented in the UKMEO tables as the method ‘DMPA. For women using intramuscular
notethisterone enantate (NET-EN), which is not licensed in the UK for long-term
contraception, the UKMEC categories are considered the same as for DMPA
here are theoretical concerns that higher doses of progestogen in injectables and longer
duration of action may be associated with increased risk compared to IMP and POP in some
Conditions. The higher UKMEC classifications reflect this.
a u
Progestogen-only pill (POP)
‘The recommendations in the UKMEC refer to the POP currently available in the UK which
‘contain either norethisterone (NET) 350 pg, LNG 30 ug or desogestrel (OSG) 75 ug.
‘Theoretically, the DSG pill may be expected to be more effective than traditional POP,
‘especially with typical use, because ovulation is suppressed more consistently and it has a
longer missed pil window“
=
‘The recommendations in the UKMEC refer to the POP currently available in the UK which
‘contain either norethisterone (NET) 350 pg, LNG 30 ug or desogestrel (OSG) 75 ug.
‘Theoretically, the DSG pill may be expected to be more effective than traditional POP,
‘especially with typical use, because ovulation is suppressed more consistently and it has a
longer missed pil window“
=
NesRHE EE.
Progestogen-niy Contraception POC) POC do ot protect against SUM there I arlk of SMV (clung
Progestogeety pi POP) ‘tring pregnancy or pospert te caret and Content use of
Progesogerenty please: depor condoms a recohmened eter alone or with ane comraceeon
Imearonprogesteroneaetate(ONPA) method Mae condome reduc ne ek a STN.
Progesogeronty plant (HP)
conomon SATECORT,
“See nésinnl comm tend ot | L= Moon C= Corman | CLARIICAMONENDENCE:
sien COIE
PERSONAL CHARACTERISTICS AND REPRODUCTIVE HISTORY
Pregnancy NA | na | NA | Clarification: There isno known ham
{othe woman, the course of pregnancy
forthe fetus POC I accidental used
uring pregnancy.
8) Menarche to <18 years [2 | 1 ]eianncation:Agudaine tom the
SET 7 1177| Naot nto dr Heat and Care
D 10-45 yore Excelence (NICE) recommends that
©) 45 years 3 | 2 | 1 | women shouldbe informed hat use
of DMPA IE associated wth a smal
reduction in bone mineral densty
(GMD) but hs usualy recovers ater
(desontinunien. Evidence fr any long:
term efects of OMPA on EMO in women
aged <18 yearsis lacking”
Evidence on long term fracture risk is
sparse bik women choosing lo continue
DMPA shouldbe reviewed every 2 years
to assess indaual stuaons and to
seuss the risks and beneftsViemen
Should e supported inthe choice of
“ether na 10 conti. In women
aged <18 years, OMPA can be used as
sine option ater consideration of
tier methods”
2) Nuliparous CC
D) Parous ri [il
Tandon be DIU DA OS DA A DE ES
MMI nn most room más Teno enc cotas por, nce
ÉTAT AE EEE wala a
Progestogen-niy Contraception POC) POC do ot protect against SUM there I arlk of SMV (clung
Progestogeety pi POP) ‘tring pregnancy or pospert te caret and Content use of
Progesogerenty please: depor condoms a recohmened eter alone or with ane comraceeon
Imearonprogesteroneaetate(ONPA) method Mae condome reduc ne ek a STN.
Progesogeronty plant (HP)
conomon SATECORT,
“See nésinnl comm tend ot | L= Moon C= Corman | CLARIICAMONENDENCE:
sien COIE
PERSONAL CHARACTERISTICS AND REPRODUCTIVE HISTORY
Pregnancy NA | na | NA | Clarification: There isno known ham
{othe woman, the course of pregnancy
forthe fetus POC I accidental used
uring pregnancy.
8) Menarche to <18 years [2 | 1 ]eianncation:Agudaine tom the
SET 7 1177| Naot nto dr Heat and Care
D 10-45 yore Excelence (NICE) recommends that
©) 45 years 3 | 2 | 1 | women shouldbe informed hat use
of DMPA IE associated wth a smal
reduction in bone mineral densty
(GMD) but hs usualy recovers ater
(desontinunien. Evidence fr any long:
term efects of OMPA on EMO in women
aged <18 yearsis lacking”
Evidence on long term fracture risk is
sparse bik women choosing lo continue
DMPA shouldbe reviewed every 2 years
to assess indaual stuaons and to
seuss the risks and beneftsViemen
Should e supported inthe choice of
“ether na 10 conti. In women
aged <18 years, OMPA can be used as
sine option ater consideration of
tier methods”
2) Nuliparous CC
D) Parous ri [il
Tandon be DIU DA OS DA A DE ES
MMI nn most room más Teno enc cotas por, nce
ÉTAT AE EEE wala a
Progetogenany Contraception POC) POC do nt protect against STVAN teres lk of STI (nen,
Progetogen ny ll POP) ‘ring peegancy or pompa) the correct and consitert ure ot
Propestoperenyhfecae:depot condoms reconmened effet sone or wr anaercoracepion
Progestogen-onıyImplant (MP) 2 E
Se con commente encor |. itn, C= Connon CLARIFCATIONEWDENCE
“con
Postpartum fn breasted
Doe ada cames
b) 26 weeks to <6 months 7 1 E cee
o an nin pim and
E 5 e generally demonstrates no hamnfud
Gammes ce mm mc
Seger
PIE Gaston amade yore
ie CN a] a nae vn 26 ve
mann anne CN EN r
inter POC mayb ey
ERIC ros wey
Soe res
mener amet | 1 | 2 |_| meter, tou ne
Mana ana CN Nc + Ses
= 11T
tarification: Other risk factors for.
VTE, such as immeblty, transuión
at diver, BMI >30 ka, postpartum
haemorrhage, immediately pos
m
Serer
mene
— en
Seen
D) Second nmester 1 [+ [4 a ran
©) Postaberton sepas apa
POC can be states inmedaely
faloning surgical abortion or medical
shorten
NOIA an DIE ven ROG una IA me TAT ONT
DE maps aus mol cnc una snr tea sap em pov, ance
Seine mens a soe ma nite neon wen nace ut
Progetogen ny ll POP) ‘ring peegancy or pompa) the correct and consitert ure ot
Propestoperenyhfecae:depot condoms reconmened effet sone or wr anaercoracepion
Progestogen-onıyImplant (MP) 2 E
Se con commente encor |. itn, C= Connon CLARIFCATIONEWDENCE
“con
Postpartum fn breasted
Doe ada cames
b) 26 weeks to <6 months 7 1 E cee
o an nin pim and
E 5 e generally demonstrates no hamnfud
Gammes ce mm mc
Seger
PIE Gaston amade yore
ie CN a] a nae vn 26 ve
mann anne CN EN r
inter POC mayb ey
ERIC ros wey
Soe res
mener amet | 1 | 2 |_| meter, tou ne
Mana ana CN Nc + Ses
= 11T
tarification: Other risk factors for.
VTE, such as immeblty, transuión
at diver, BMI >30 ka, postpartum
haemorrhage, immediately pos
m
Serer
mene
— en
Seen
D) Second nmester 1 [+ [4 a ran
©) Postaberton sepas apa
POC can be states inmedaely
faloning surgical abortion or medical
shorten
NOIA an DIE ven ROG una IA me TAT ONT
DE maps aus mol cnc una snr tea sap em pov, ance
Seine mens a soe ma nite neon wen nace ut
SR
ProgestogencntyCortracepton POC) POC donot protect agaist STUHN. Iter I arlk of SV (cu
Progestageety (POP “rng pregnancy or poster) he cect and constr seo
Poe lea Sanne comanda sae wth mer coton
Present mpl (ME)
conomon SATECORT,
“See nésinnl comm tend ot | L= Moon C= Corman | CLARIICAMONENDENCE:
sien COIE
Past ectopic pregnancy T | + | + | Claritcation: At POC reduce the sk of
pregnancy (intrauterina and etrauterne)
History of polvi surgery CR
Smoking ‘Clarification: UKMEC curenty does
rot indude use of ecgartes, as sks
2) Age <35 years 1 [ 1 [1] assccites wth ei use are not yet
by Age 235 years estables
© SiS cigareesiday A] [1 | poc dont appear to nrease me sk of
(215 ciaretesiiay 1 La een in anclas
(W Stopped smoking <1 year 3 [4 [1 _| mme maraty rte som al causes
(including cancers) decreases o that of
( Stopped smoking 21 year mas jen.
ssesion, The CUD risk associated with
Smoking decreases vin 110 5 years of
Smoking cessaton "à The 35 year age
tuto is rind because any excess
moralty associated wih smoking 1 nly
apparent om tis age"
=
2) BM 230-34 gim" 3 13 | 1 j'emnce nage quico, Amen,
à oe Sut women rere na o steilen.
DIETZ 1 | 1 [1 re
ra
Seng DM cme er
[MPA Users with some studies obser.
(gene weig an among bss mena
Frost Roma rg ers jet obet
Ser FOG made ond wag ses
potted
or: POE
AAA tae”
ProgestogencntyCortracepton POC) POC donot protect agaist STUHN. Iter I arlk of SV (cu
Progestageety (POP “rng pregnancy or poster) he cect and constr seo
Poe lea Sanne comanda sae wth mer coton
Present mpl (ME)
conomon SATECORT,
“See nésinnl comm tend ot | L= Moon C= Corman | CLARIICAMONENDENCE:
sien COIE
Past ectopic pregnancy T | + | + | Claritcation: At POC reduce the sk of
pregnancy (intrauterina and etrauterne)
History of polvi surgery CR
Smoking ‘Clarification: UKMEC curenty does
rot indude use of ecgartes, as sks
2) Age <35 years 1 [ 1 [1] assccites wth ei use are not yet
by Age 235 years estables
© SiS cigareesiday A] [1 | poc dont appear to nrease me sk of
(215 ciaretesiiay 1 La een in anclas
(W Stopped smoking <1 year 3 [4 [1 _| mme maraty rte som al causes
(including cancers) decreases o that of
( Stopped smoking 21 year mas jen.
ssesion, The CUD risk associated with
Smoking decreases vin 110 5 years of
Smoking cessaton "à The 35 year age
tuto is rind because any excess
moralty associated wih smoking 1 nly
apparent om tis age"
=
2) BM 230-34 gim" 3 13 | 1 j'emnce nage quico, Amen,
à oe Sut women rere na o steilen.
DIETZ 1 | 1 [1 re
ra
Seng DM cme er
[MPA Users with some studies obser.
(gene weig an among bss mena
Frost Roma rg ers jet obet
Ser FOG made ond wag ses
potted
or: POE
AAA tae”
Progetogenany Contraception POC) POC do nt protect against STVAN teres lk of STI (nen,
Progetogen ny ll POP) ‘ring peegancy or pompa) the correct and consitert ure ot
Propestoperenyhfecae:depot condoms reconmened effet sone or wr anaercoracepion
Iearonprogeteonsactate OMPR) Mathod Mae condoms rec ne sol STM.
Propestoperony plot 1)
— ‘CATEGORY
“See con commente encor |. itn, C= Connon CLARIFCATIONEWDENCE
“con
we | ou | POP
CSE
SE E or
: ee oe
i og A RR St ae
Win Shot NI 000
eine
ER
Evidence: Limited evidence
demensirates no subtotal decrease in
‘ectveness of ral corracopión among
“omen ho underwent apareecope
Placement of an adjustable gasi band.”
LUmted evidence demonstrates no
subsantal decrease in efeciveness of
(al coraceptien among women who
Undergo a bilopanereate derson:
however etdence am pharmaccxinete
studies suggests coming results of
oral contraception efeciveness among
“women who undergo a june lea
==
—
menge ||, | a
ES
o E eres rere
Mak factors exe th ek of CVD may
Increase substantaly
2 E
DIAM orson cans ters on st aora aio tac pov sce
Steet minors ely ind ao ser sepa meas a ala ok
Progetogen ny ll POP) ‘ring peegancy or pompa) the correct and consitert ure ot
Propestoperenyhfecae:depot condoms reconmened effet sone or wr anaercoracepion
Iearonprogeteonsactate OMPR) Mathod Mae condoms rec ne sol STM.
Propestoperony plot 1)
— ‘CATEGORY
“See con commente encor |. itn, C= Connon CLARIFCATIONEWDENCE
“con
we | ou | POP
CSE
SE E or
: ee oe
i og A RR St ae
Win Shot NI 000
eine
ER
Evidence: Limited evidence
demensirates no subtotal decrease in
‘ectveness of ral corracopión among
“omen ho underwent apareecope
Placement of an adjustable gasi band.”
LUmted evidence demonstrates no
subsantal decrease in efeciveness of
(al coraceptien among women who
Undergo a bilopanereate derson:
however etdence am pharmaccxinete
studies suggests coming results of
oral contraception efeciveness among
“women who undergo a june lea
==
—
menge ||, | a
ES
o E eres rere
Mak factors exe th ek of CVD may
Increase substantaly
2 E
DIAM orson cans ters on st aora aio tac pov sce
Steet minors ely ind ao ser sepa meas a ala ok
Progesogenty Contraception POC) POC donot protect agaist STUHN. Iter I arlk of SV (cu
Progesogeronty pi POF) ‘tring pregnancy or pospert te caret and Content use of
Pogeiogenen Hei: epa Conde recaen ee ae ot ih ante conca
Progesogeronty plant (HP)
conpmon ‘CATEGORY
“See aasionalconmentestendot | tibia, = Continuo ‘CLARIFICATONEVIOENCE
= COMET
Focal categotes of hypertension,
Enssifeabens are based onthe
‘a)Adequaelycontalled hypertension | 4 | 2 | 4 | cteafeafone are Based on te
for CVD exist. Viven mutiple risk
{eters do exi, tak of CVO may
inerense subetanaty
Clarification: Women adequately
reed for hypertension are at a
reduced ik of acute myocardial
Infarction (and stroke compared
‘wih untreated hypertensive women,
Alnough there are no data, POC
) Consistent elevated BP levels sera vi adequately antrled aná
Cet pen) Imontored ypetensien sul be at
caducada sets M an stake
6 Sysote>140—159mmHigor | 1 | 1 | 1 | compared wit vested yperenshe
baste > 90-20 mg POC users Anthypetensive
m yl 2160 ng or {terapy maybe ntsted when the
oo mato 1] 2 | 1 | BPizeonnnenty 160/10 mig or
Eviden Limited evidence suggests
{hat among women wth hypertension,
nose who Used POP of OMPA have à
‘Small increased rik of carcovascula
vents compared with women uho do
na use these methods.
©) Vascular dense 2 | 3 | 2 | Clarification: vascuordicoase
Inetides! coronary heat disease
presenting wih angina, peripheral
Vascular disease presenting with
Intemitent laudeaton, hypertensive
retinopathy and TI.
Tandon be ators UI DA OS Wa A DO RTH HOOT
CU RE EE ear
Progesogeronty pi POF) ‘tring pregnancy or pospert te caret and Content use of
Pogeiogenen Hei: epa Conde recaen ee ae ot ih ante conca
Progesogeronty plant (HP)
conpmon ‘CATEGORY
“See aasionalconmentestendot | tibia, = Continuo ‘CLARIFICATONEVIOENCE
= COMET
Focal categotes of hypertension,
Enssifeabens are based onthe
‘a)Adequaelycontalled hypertension | 4 | 2 | 4 | cteafeafone are Based on te
for CVD exist. Viven mutiple risk
{eters do exi, tak of CVO may
inerense subetanaty
Clarification: Women adequately
reed for hypertension are at a
reduced ik of acute myocardial
Infarction (and stroke compared
‘wih untreated hypertensive women,
Alnough there are no data, POC
) Consistent elevated BP levels sera vi adequately antrled aná
Cet pen) Imontored ypetensien sul be at
caducada sets M an stake
6 Sysote>140—159mmHigor | 1 | 1 | 1 | compared wit vested yperenshe
baste > 90-20 mg POC users Anthypetensive
m yl 2160 ng or {terapy maybe ntsted when the
oo mato 1] 2 | 1 | BPizeonnnenty 160/10 mig or
Eviden Limited evidence suggests
{hat among women wth hypertension,
nose who Used POP of OMPA have à
‘Small increased rik of carcovascula
vents compared with women uho do
na use these methods.
©) Vascular dense 2 | 3 | 2 | Clarification: vascuordicoase
Inetides! coronary heat disease
presenting wih angina, peripheral
Vascular disease presenting with
Intemitent laudeaton, hypertensive
retinopathy and TI.
Tandon be ators UI DA OS Wa A DO RTH HOOT
CU RE EE ear
Progetogenany Contraception POC) POC do nt protect against STVAN teres lk of STI (nen,
Progetogen ny ll POP) ‘ring pregrancy or porpartan the correct and consistente ot
Progestoperayifecabe: depor Eons recomended. ether Alone er hn anor contraception
Iedronprogeteronssetate(OWPR) Method Mae condoms rec he isk of SIN.
Propestoperony plot 1)
“See con commente encor |. itn, C= Connon CLARIFCATIONEWDENCE
“con
History of high BP during pregnancy
‘Current and history of ischaemic ‘larification: The duraton of use of
narcisos FE eran ode ona! soso
Sid be cry conde en
cling wheter dese coimas of
Se y error dele wer eet co
Evidence: Cost tues do nt show
Snineoased iss of and owe
Users foo
Known dyslpidaomias. (lariiction: Rautine sesening or
frase genet mutations len cost
ai,
Increased levels of teal hotte,
Known, severe, genes tp dcrders
Seat mue higher Meme risk 1
{Si and may arant er ie
Sonaideraion
8) History of VTE Cia ation: nudes DVT and PE
D) Curent VTE (enantcoapuanis) | 2 | 2 | 2 |Emdence To dre deceo
N x E Ben POS aang ween win BPE
on arécongan Dep Aoug dates
Encontre onen by moran
Sry anal caos à non est
Dan ath COC, Ute nes
Ina it ne
feces apra theca he
Ficken ns urea the ek am ce
iter aga ec
cocos ca
RE snr tera sans rege pov, ance
Steet minors ely ind ao ser sepa meas a ala ok
Progetogen ny ll POP) ‘ring pregrancy or porpartan the correct and consistente ot
Progestoperayifecabe: depor Eons recomended. ether Alone er hn anor contraception
Iedronprogeteronssetate(OWPR) Method Mae condoms rec he isk of SIN.
Propestoperony plot 1)
“See con commente encor |. itn, C= Connon CLARIFCATIONEWDENCE
“con
History of high BP during pregnancy
‘Current and history of ischaemic ‘larification: The duraton of use of
narcisos FE eran ode ona! soso
Sid be cry conde en
cling wheter dese coimas of
Se y error dele wer eet co
Evidence: Cost tues do nt show
Snineoased iss of and owe
Users foo
Known dyslpidaomias. (lariiction: Rautine sesening or
frase genet mutations len cost
ai,
Increased levels of teal hotte,
Known, severe, genes tp dcrders
Seat mue higher Meme risk 1
{Si and may arant er ie
Sonaideraion
8) History of VTE Cia ation: nudes DVT and PE
D) Curent VTE (enantcoapuanis) | 2 | 2 | 2 |Emdence To dre deceo
N x E Ben POS aang ween win BPE
on arécongan Dep Aoug dates
Encontre onen by moran
Sry anal caos à non est
Dan ath COC, Ute nes
Ina it ne
feces apra theca he
Ficken ns urea the ek am ce
iter aga ec
cocos ca
RE snr tera sans rege pov, ance
Steet minors ely ind ao ser sepa meas a ala ok
NesRHE EE.
Progesogenty Contraception POC) POC donot protect agaist STUHN. Iter I arlk of SV (cu
Progesogeronty pi POF) ‘tring pregnancy or pospert te caret and Content use of
Progesogerenty please: depor condoms a recohmened eter alone or with ane comraceeon
ec os. Male condoms reduce the ik of STAN,
conomon SATECORT,
“See nésinnl comm tend ot | L= Moon C= Corman | CLARIICAMONENDENCE:
sien COIE
©) Famiy soy of VTE
D Frstdegree relative rss
age cis years,
(0 Frst-degree relative EN E
age 2 years
© Major surgery Major surgery Inddes major eeaive
ger (30 minutes duration) and a
Dwänprongesimmatisaien | 2 | 2 | 2 | Gare eraurgerywnir
Wet plongee | 1 | 1 | 1 | lobes prolonged inmobisaton ofa
tower im
©) Mnoraugeryweutimmebtsaten | 1 | 1 | +
9 inmosity(unetestosugem | 1 | 1 | 1 | Minor surgery: Includes operations
(e Mecenas use, esta Ines) Eating <20 inte wth sort curation
of anaesthesia (eg. laparoscopic
Sensation or loch entracion)
venous thrombosis
2) Varicose veins E EC
D) Superf venous tombes CECI
2 | 2 | 2 | clrtcaton Rowtne cerening or
(ep. fader V Leiden protvonbin these genetic mutations isnt cos
mulation, protein ©. prte Cand effective”
cero aca
ü roms dy malos eaares mper cin ópera and Tl à cm comacepive Eier, anca
ÉTAT nenn chen he A AS
Progesogenty Contraception POC) POC donot protect agaist STUHN. Iter I arlk of SV (cu
Progesogeronty pi POF) ‘tring pregnancy or pospert te caret and Content use of
Progesogerenty please: depor condoms a recohmened eter alone or with ane comraceeon
ec os. Male condoms reduce the ik of STAN,
conomon SATECORT,
“See nésinnl comm tend ot | L= Moon C= Corman | CLARIICAMONENDENCE:
sien COIE
©) Famiy soy of VTE
D Frstdegree relative rss
age cis years,
(0 Frst-degree relative EN E
age 2 years
© Major surgery Major surgery Inddes major eeaive
ger (30 minutes duration) and a
Dwänprongesimmatisaien | 2 | 2 | 2 | Gare eraurgerywnir
Wet plongee | 1 | 1 | 1 | lobes prolonged inmobisaton ofa
tower im
©) Mnoraugeryweutimmebtsaten | 1 | 1 | +
9 inmosity(unetestosugem | 1 | 1 | 1 | Minor surgery: Includes operations
(e Mecenas use, esta Ines) Eating <20 inte wth sort curation
of anaesthesia (eg. laparoscopic
Sensation or loch entracion)
venous thrombosis
2) Varicose veins E EC
D) Superf venous tombes CECI
2 | 2 | 2 | clrtcaton Rowtne cerening or
(ep. fader V Leiden protvonbin these genetic mutations isnt cos
mulation, protein ©. prte Cand effective”
cero aca
ü roms dy malos eaares mper cin ópera and Tl à cm comacepive Eier, anca
ÉTAT nenn chen he A AS
Progetogenany Contraception POC) POC do nt protect against STVAN teres lk of STI (nen,
Progetogen ny ll POP) ‘ring peegancy or pompa) the correct and consitert ure ot
Propestoperenyhfecae:depot condoms reconmened effet sone or wr anaercoracepion
Progestogen-onıyImplant (MP) 2 E
conso caTEcoRr
“See métal commen dot | 1= Men. C= Contnsten CLARIICATIONEMOENCE
sien mue oma] POP
Var and congenital heart
2) Uncomplicated 1 [1 [1 | eterfeation: Uncompicaed cases
an be considered where: tere s (no
b) Complicated (eg. pulmonary 1 1 en
Fuptenson. history of subacute the woman is asymptomate andi) a
bacterial endocaratis),
carilogy review is require annually
ttle. Im dot isussion tha
Spécial cardologa Is advised
Vat hear disease Occurs when
any ofthe heart valves ae stenate
andlr incompetente. acte
Stenosis, mal regurgitation, tricuspid
Vale abnermalies, pulmonary
Stenosis)”
Congental heat disease: Aortic
Stenosis, anal septal defects,
riovencular seta defect,
Eardomyopathy (hypertrophic or
late), coarctation ofthe aa,
complex transposon ofthe
great arenes, Ens anomaly
Eisenmenger synrame, patent
ductus anenosus, pulmonary atresia
puimenary steno, tetralogy of Falk,
Total anemalouspuimonary venous
connection. tcuspld atresia, runcus
teriosus, venta septal ete
2 E
DIAM orson cans ters on st aora aio tac pov sce
Steet minors ely ind ao ser sepa meas a ala ok
Progetogen ny ll POP) ‘ring peegancy or pompa) the correct and consitert ure ot
Propestoperenyhfecae:depot condoms reconmened effet sone or wr anaercoracepion
Progestogen-onıyImplant (MP) 2 E
conso caTEcoRr
“See métal commen dot | 1= Men. C= Contnsten CLARIICATIONEMOENCE
sien mue oma] POP
Var and congenital heart
2) Uncomplicated 1 [1 [1 | eterfeation: Uncompicaed cases
an be considered where: tere s (no
b) Complicated (eg. pulmonary 1 1 en
Fuptenson. history of subacute the woman is asymptomate andi) a
bacterial endocaratis),
carilogy review is require annually
ttle. Im dot isussion tha
Spécial cardologa Is advised
Vat hear disease Occurs when
any ofthe heart valves ae stenate
andlr incompetente. acte
Stenosis, mal regurgitation, tricuspid
Vale abnermalies, pulmonary
Stenosis)”
Congental heat disease: Aortic
Stenosis, anal septal defects,
riovencular seta defect,
Eardomyopathy (hypertrophic or
late), coarctation ofthe aa,
complex transposon ofthe
great arenes, Ens anomaly
Eisenmenger synrame, patent
ductus anenosus, pulmonary atresia
puimenary steno, tetralogy of Falk,
Total anemalouspuimonary venous
connection. tcuspld atresia, runcus
teriosus, venta septal ete
2 E
DIAM orson cans ters on st aora aio tac pov sce
Steet minors ely ind ao ser sepa meas a ala ok
SR
ProgestogencntyCortracepton POC) POC donot protect agaist STUHN. Iter I arlk of SV (cu
Progesogeronty pi POF) ‘tring pregnancy or pospert te caret and Content use of
Pogeiogenen Hei: epa Conde recaen ee ae ot ih ante conca
Progesogeronty plant (HP)
conpmon CATEGORY
“See aasionalconmentestendot | tibia, = Continuo ‘CLARIFICATONEVIOENCE
pe
COMET
Cardiomyopathy
2) Norma cardiac function A] [1 elariteation: A weman whe is nat on
D) psec ton EN us
Evidence: No dret evidence exists on
the safety of POC among women with
cardiomyopathy. Limited indirect evidence
from non-comparatve studies of women
vith card disease demonstrates few
cases ohyperensen, Iromboembolsm
and hear alu in men wth cardiac
disease using POP and DMPA"
Cardiac artythmias
2) Aal lation 22 | 2
D) Know long QT syndrome 12 [1 | Evidence: case reports suggest
‘exacerbation of LOTS2 with use of OMPA
as postpartum eenracepion |
wo? arcada
MMI nn most meu piper más Teno enc cotas por, nce
ÉTAT AE EEE wala a
ProgestogencntyCortracepton POC) POC donot protect agaist STUHN. Iter I arlk of SV (cu
Progesogeronty pi POF) ‘tring pregnancy or pospert te caret and Content use of
Pogeiogenen Hei: epa Conde recaen ee ae ot ih ante conca
Progesogeronty plant (HP)
conpmon CATEGORY
“See aasionalconmentestendot | tibia, = Continuo ‘CLARIFICATONEVIOENCE
pe
COMET
Cardiomyopathy
2) Norma cardiac function A] [1 elariteation: A weman whe is nat on
D) psec ton EN us
Evidence: No dret evidence exists on
the safety of POC among women with
cardiomyopathy. Limited indirect evidence
from non-comparatve studies of women
vith card disease demonstrates few
cases ohyperensen, Iromboembolsm
and hear alu in men wth cardiac
disease using POP and DMPA"
Cardiac artythmias
2) Aal lation 22 | 2
D) Know long QT syndrome 12 [1 | Evidence: case reports suggest
‘exacerbation of LOTS2 with use of OMPA
as postpartum eenracepion |
wo? arcada
MMI nn most meu piper más Teno enc cotas por, nce
ÉTAT AE EEE wala a
Progetogenany Contraception POC) POC do nt protect against STVAN teres lk of STI (nen,
Progetogen ny ll POP) ‘ring peegancy or pompa) the correct and consitert ure ot
Propestoperenyhfecae:depot condoms reconmened effet sone or wr anaercoracepion
Iearonprogeteonsactate OMPR) Mathod Mae condoms rec ne sol STM.
Propestoperony plot 1)
— ‘CATEGORY
“See con commente encor |. itn, C= Connon CLARIFCATIONEWDENCE
“con
we | ou | POP
IEUROLOGICAL CONDITIONS
2 Normigananmigersmae | 1 | 1 | 1 enon: nance na coon
D Maine ane manage | 2 | 2 FE conden ein women dre
DE
donee Few aus have sect
memes | 2 | 2 | Ton cuestas mete
0 Heysyanssmeimmane | 2 | 2 | 2 | Reveare studs compas sche
an POG pa meme al oc
con migra ls et dear However theres
o evidence ta! the use of progestogen
(nly POC is associated wth an increased
tok afischaemie stroke.
Classitcaton depends on making an
accurate diagnosis ofthose severe
headaches that ae migranous and. in
‘ation, those completed by au
Ses addition resource on diagnosis of
migraines wth or without aura
Iaiopathi intracranial ca
ypertension (IM).
Enilepsy Lol
Taking anthepleptic drugs “Getainant-eploptc drugs have the potetlto arc the
Eioavalably otero hormones in hormonal contraception. in
_daiton,hrmenal contraception may ae e levels of certain ant
«plegt drugs wth potential adverse et
Forup-10-dae information on the potential drug interactions between
hormonal contraception and antrepleptic drugs, please refer tothe
‘ine drag interaction checker valable on Stockley’ interacton
Checker webate
NOIA ann m BOS ven ROG una IA DO TAT DOT
MMMM orson cans ters on st aora aio tac pov sce
Steet minors ely ind ao ser sepa meas a ala ok
Progetogen ny ll POP) ‘ring peegancy or pompa) the correct and consitert ure ot
Propestoperenyhfecae:depot condoms reconmened effet sone or wr anaercoracepion
Iearonprogeteonsactate OMPR) Mathod Mae condoms rec ne sol STM.
Propestoperony plot 1)
— ‘CATEGORY
“See con commente encor |. itn, C= Connon CLARIFCATIONEWDENCE
“con
we | ou | POP
IEUROLOGICAL CONDITIONS
2 Normigananmigersmae | 1 | 1 | 1 enon: nance na coon
D Maine ane manage | 2 | 2 FE conden ein women dre
DE
donee Few aus have sect
memes | 2 | 2 | Ton cuestas mete
0 Heysyanssmeimmane | 2 | 2 | 2 | Reveare studs compas sche
an POG pa meme al oc
con migra ls et dear However theres
o evidence ta! the use of progestogen
(nly POC is associated wth an increased
tok afischaemie stroke.
Classitcaton depends on making an
accurate diagnosis ofthose severe
headaches that ae migranous and. in
‘ation, those completed by au
Ses addition resource on diagnosis of
migraines wth or without aura
Iaiopathi intracranial ca
ypertension (IM).
Enilepsy Lol
Taking anthepleptic drugs “Getainant-eploptc drugs have the potetlto arc the
Eioavalably otero hormones in hormonal contraception. in
_daiton,hrmenal contraception may ae e levels of certain ant
«plegt drugs wth potential adverse et
Forup-10-dae information on the potential drug interactions between
hormonal contraception and antrepleptic drugs, please refer tothe
‘ine drag interaction checker valable on Stockley’ interacton
Checker webate
NOIA ann m BOS ven ROG una IA DO TAT DOT
MMMM orson cans ters on st aora aio tac pov sce
Steet minors ely ind ao ser sepa meas a ala ok
Ne
FSRH Rda.
Progestogeory Contraception POC) POC deat protect against STUMI. eres risk of STIM (nung
Progestogerony pil POP ‘uring pregnaney or pespartan) the crrect and consiste use of
Progesogerenty please: depor condoms a recohmened eter alone or with ane comraceeon
‘mewonyprogeserne acctate (NPA) Method Male condoms reduce he iak SIN
Progestogeronty mara (ue)
conomon SATECORT,
“See nésinnl comm tend ot | L= Moon C= Corman | CLARIICAMONENDENCE:
sien COIE
Depressive disorder 3 T + T + | elariteation: The dassiteation
Is based en data for women wth
Selected depressive cserers. No data
are avaiable on bipolar disorder or
postpartum depression.
Evidence: POC uses not shown
10 increase depressive symptoms in
women with depression compared wth
RZ
2) lrepuar pattern wihoutheay | 2 | 2 | 2 | Clarification: Abnermal menstual
bleeding Bleeding shoul rise suspicion of
serious underlying condion and be
o) Heavy or prolonged bleeding | 2 [2/2 a
includes regular and regular nus
pates) Bleeding pattems in women using FOC
are often ateos parta in the intial
months of use and may net sete wth
ane
Unexplained vaginal bleeding? 3 1 2 | 2 | etmifcation: pregnancy or an
suspicions for señous conan) underying pthlogca condtion (uch as
before evaluation pele malgnaney)!s suspected, must
Endometriosis sil
Benign ovarian tumours sil
Severe dysmenorthoea 00 a E
be evaluated andthe category adjusted
tier evaluation
Tandon be ators UI DA OS Wa A DO RTH HOOT
BEER mos ese mosca pene ands rare wea coterie rr sce
Oe ne asco comers ae ero nee sel al
FSRH Rda.
Progestogeory Contraception POC) POC deat protect against STUMI. eres risk of STIM (nung
Progestogerony pil POP ‘uring pregnaney or pespartan) the crrect and consiste use of
Progesogerenty please: depor condoms a recohmened eter alone or with ane comraceeon
‘mewonyprogeserne acctate (NPA) Method Male condoms reduce he iak SIN
Progestogeronty mara (ue)
conomon SATECORT,
“See nésinnl comm tend ot | L= Moon C= Corman | CLARIICAMONENDENCE:
sien COIE
Depressive disorder 3 T + T + | elariteation: The dassiteation
Is based en data for women wth
Selected depressive cserers. No data
are avaiable on bipolar disorder or
postpartum depression.
Evidence: POC uses not shown
10 increase depressive symptoms in
women with depression compared wth
RZ
2) lrepuar pattern wihoutheay | 2 | 2 | 2 | Clarification: Abnermal menstual
bleeding Bleeding shoul rise suspicion of
serious underlying condion and be
o) Heavy or prolonged bleeding | 2 [2/2 a
includes regular and regular nus
pates) Bleeding pattems in women using FOC
are often ateos parta in the intial
months of use and may net sete wth
ane
Unexplained vaginal bleeding? 3 1 2 | 2 | etmifcation: pregnancy or an
suspicions for señous conan) underying pthlogca condtion (uch as
before evaluation pele malgnaney)!s suspected, must
Endometriosis sil
Benign ovarian tumours sil
Severe dysmenorthoea 00 a E
be evaluated andthe category adjusted
tier evaluation
Tandon be ators UI DA OS Wa A DO RTH HOOT
BEER mos ese mosca pene ands rare wea coterie rr sce
Oe ne asco comers ae ero nee sel al
Progetogenany Contraception POC) POC do nt protect against STVAN teres lk of STI (nen,
Progetogen ny ll POP) ‘ring pregrancy or porpartan the correct and consistente ot
Propestoperenyhfecae:depot condoms reconmened effet sone or wr anaercoracepion
Iearonprogeteonsactate OMPR) Mathod Mae condoms rec ne sol STM.
Propestoperony plot 1)
“See con commente encor |. itn, C= Connon CLARIFCATIONEWDENCE
“con
‘Gestational trophobla
(sro)
2) Undetedable hCG leves ils
(complete an paral and gestaional
D) Decreasing hCG levels a [4 ECT | Soa anton
©) Persie elevatedhCGleves | 1 | 1 | 1
cor malignant disease A small study which included women
Using POP and OMA concluded hat
ren use ofhormenal contraception
Inc associated wit development ot
gestational rophobiaste neoplasa or
elayed me 10 CG remission”
Cervical 7 | 2 | 1 | Evidence: Among women wih persistent
(en) human papiloma vas (HPV) infection,
Lang term DMPA ue (25 years) may
increase the risk of earanoma in stand
2) Avating treatment 2 | 2 | 1 | ciaricaion Theres some theretcal
{concern at POC use coul act
prognosis ofthe ensing disease, While
wang teatment, women may use
Poe.
D Radical acheletomy zizi:
2 E
DIAM orson cans ters on st aora aio tac pov sce
Seine mens a soe ma nite neon wen nace ut
Progetogen ny ll POP) ‘ring pregrancy or porpartan the correct and consistente ot
Propestoperenyhfecae:depot condoms reconmened effet sone or wr anaercoracepion
Iearonprogeteonsactate OMPR) Mathod Mae condoms rec ne sol STM.
Propestoperony plot 1)
“See con commente encor |. itn, C= Connon CLARIFCATIONEWDENCE
“con
‘Gestational trophobla
(sro)
2) Undetedable hCG leves ils
(complete an paral and gestaional
D) Decreasing hCG levels a [4 ECT | Soa anton
©) Persie elevatedhCGleves | 1 | 1 | 1
cor malignant disease A small study which included women
Using POP and OMA concluded hat
ren use ofhormenal contraception
Inc associated wit development ot
gestational rophobiaste neoplasa or
elayed me 10 CG remission”
Cervical 7 | 2 | 1 | Evidence: Among women wih persistent
(en) human papiloma vas (HPV) infection,
Lang term DMPA ue (25 years) may
increase the risk of earanoma in stand
2) Avating treatment 2 | 2 | 1 | ciaricaion Theres some theretcal
{concern at POC use coul act
prognosis ofthe ensing disease, While
wang teatment, women may use
Poe.
D Radical acheletomy zizi:
2 E
DIAM orson cans ters on st aora aio tac pov sce
Seine mens a soe ma nite neon wen nace ut
SR
ProgestogencntyCortracepton POC) POC donot protect agaist STUHN. Iter I arlk of SV (cu
Progestageety (POP “rng pregnancy or poster) he cect and constr seo
Poe lea Sanne comanda sae wth mer coton
Present mpl (ME)
conomon SATECORT,
“See nésinnl comm tend ot | L= Moon C= Corman | CLARIICAMONENDENCE:
con
COMET
Breast cond
3) Undiagnosed masshreast 2 | 2 | 2 | ctatcation: Breast cancerisa
‘simptoms hormonal senstive tumour andtherefoe
‘the progress of waren wih eurent of
pas breast cancer may be acte by
hormonal methods of cenracepton.
1) Benign breast conditions sil
©) Famiyhisory ofbreasteances | ı | 1 | 7
©) Carries otknown gene mutations | 2 | 2 | 2
‘sociated with brea cancer e
BROMBRCAZ)
©) Breast cancer (Clarion; For women with a history
of breast cancer te deci ont
(0 Current breast cancer 4 | 4 | + | hormonal cenracetion may be best
(i Past breast cancer 3 | 3 | 3 | maden consulten wah the cca
encologytean.
Endometrial cancer" CI EUR la
Ovarian cancer a]
2) Without dstorion oftheuterine | 1 | 1 | 1
EN
ılı la
2) Pas PID(assumingnocurens | ı | 1 | 1
ik acters for STie)
D) Current PD JT
wo? arcada
A nn most meu piper más Teno enc cotas por, nce
A A AS
ProgestogencntyCortracepton POC) POC donot protect agaist STUHN. Iter I arlk of SV (cu
Progestageety (POP “rng pregnancy or poster) he cect and constr seo
Poe lea Sanne comanda sae wth mer coton
Present mpl (ME)
conomon SATECORT,
“See nésinnl comm tend ot | L= Moon C= Corman | CLARIICAMONENDENCE:
con
COMET
Breast cond
3) Undiagnosed masshreast 2 | 2 | 2 | ctatcation: Breast cancerisa
‘simptoms hormonal senstive tumour andtherefoe
‘the progress of waren wih eurent of
pas breast cancer may be acte by
hormonal methods of cenracepton.
1) Benign breast conditions sil
©) Famiyhisory ofbreasteances | ı | 1 | 7
©) Carries otknown gene mutations | 2 | 2 | 2
‘sociated with brea cancer e
BROMBRCAZ)
©) Breast cancer (Clarion; For women with a history
of breast cancer te deci ont
(0 Current breast cancer 4 | 4 | + | hormonal cenracetion may be best
(i Past breast cancer 3 | 3 | 3 | maden consulten wah the cca
encologytean.
Endometrial cancer" CI EUR la
Ovarian cancer a]
2) Without dstorion oftheuterine | 1 | 1 | 1
EN
ılı la
2) Pas PID(assumingnocurens | ı | 1 | 1
ik acters for STie)
D) Current PD JT
wo? arcada
A nn most meu piper más Teno enc cotas por, nce
A A AS
Progetogenany Contraception POC) POC do nt protect against STVAN teres lk of STI (nen,
Progetogen ny ll POP) ‘ring peegancy or pompa) the correct and consitert ure ot
Propestoperenyhfecae:depot condoms reconmened effet sone or wr anaercoracepion
Progestogen-onıyImplant (MP) 2 E
See addtionnl comments at end of | |= ination, © = Continuation CLARIFICATIONIEVIDENCE
= ie | omra | por
isms)
2) Chaya esto (rent) Evidence: Umdedeldene suggest
Hat ere may bs an mers kof
(i) Symptomatic 4 4 1 _| chiamydiat cervictis among DMPA users
Armand YA] semen of Sis Fer ter Sia ere
D Aemptem is ether evidence of no association
©) Parent santa or + | + [1 [ie own use a $1 acquston
Genome ete) cidos hats to ted draw
© Oner caren Ste (avan | 1 | + | + |amemusens Tees ne vence or
and hepatitis) er POC.
© Vapi Gauss meromoras | 1] 1 | +
vaginas an baderalvagnoss)
(ren.
© sensei or Sie EI BEE ER)
cu PE
DIAM orson cans ters on st aora aio tac pov sce
Steet minors ely ind ao ser sepa meas a ala ok
Progetogen ny ll POP) ‘ring peegancy or pompa) the correct and consitert ure ot
Propestoperenyhfecae:depot condoms reconmened effet sone or wr anaercoracepion
Progestogen-onıyImplant (MP) 2 E
See addtionnl comments at end of | |= ination, © = Continuation CLARIFICATIONIEVIDENCE
= ie | omra | por
isms)
2) Chaya esto (rent) Evidence: Umdedeldene suggest
Hat ere may bs an mers kof
(i) Symptomatic 4 4 1 _| chiamydiat cervictis among DMPA users
Armand YA] semen of Sis Fer ter Sia ere
D Aemptem is ether evidence of no association
©) Parent santa or + | + [1 [ie own use a $1 acquston
Genome ete) cidos hats to ted draw
© Oner caren Ste (avan | 1 | + | + |amemusens Tees ne vence or
and hepatitis) er POC.
© Vapi Gauss meromoras | 1] 1 | +
vaginas an baderalvagnoss)
(ren.
© sensei or Sie EI BEE ER)
cu PE
DIAM orson cans ters on st aora aio tac pov sce
Steet minors ely ind ao ser sepa meas a ala ok
NesRHE EE.
Progesogenty Contraception POC) POC donot protect agaist STUHN. Iter I arlk of SV (cu
Progestogeety pi POP) ‘tring pregnancy or pospert te caret and Content use of
Progesogerenty please: depor condoms a recohmened eter alone or with ane comraceeon
Imearonprogesteroneaetate(ONPA) method Mae condome reduc ne ek a STN.
Progesogeronty plant (HP)
conomon SATE OR,
“See nésinnl comment tend ot | 1= Moon C-Coninuten | CLARMICANONENDENGE.
sien me | ou | por
A
2) High isk of HIV infection T | 1 | 1 | Evidence: rin quan evidence nam
tnevrandomiaed contes tal observed
fo labaicaly sigateantaierences
Fi acqusi between, OMA
1, DMPA A versus LNG
een sad
ee
Basen
A ec a
a oS
nnd
Spenco ae
eee
Dee Re
Er
BURN acacia
NMI nn nee a nd Tent enc coa pr, nce
ÉTAT AE EEE AS
Progesogenty Contraception POC) POC donot protect agaist STUHN. Iter I arlk of SV (cu
Progestogeety pi POP) ‘tring pregnancy or pospert te caret and Content use of
Progesogerenty please: depor condoms a recohmened eter alone or with ane comraceeon
Imearonprogesteroneaetate(ONPA) method Mae condome reduc ne ek a STN.
Progesogeronty plant (HP)
conomon SATE OR,
“See nésinnl comment tend ot | 1= Moon C-Coninuten | CLARMICANONENDENGE.
sien me | ou | por
A
2) High isk of HIV infection T | 1 | 1 | Evidence: rin quan evidence nam
tnevrandomiaed contes tal observed
fo labaicaly sigateantaierences
Fi acqusi between, OMA
1, DMPA A versus LNG
een sad
ee
Basen
A ec a
a oS
nnd
Spenco ae
eee
Dee Re
Er
BURN acacia
NMI nn nee a nd Tent enc coa pr, nce
ÉTAT AE EEE AS
Progetogenany Contraception POC) POC do nt protect against STVAN teres lk of STI (nen,
Progetogen ny ll POP) ‘ring peegancy or pompa) the correct and consitert ure ot
Propestoperenyhfecae:depot condoms reconmened effet sone or wr anaercoracepion
Progestogen-onıyImplant (MP) 2 E
conso CATEGORY,
"Seal commen a endot | !=Ihtabn, C= Cotman | CLARIICAMOWEVDENCE
on
we | wpa | vor
bi RiVinfeted ‘Evidence: Five aces sueno,
og
pee = ng
DEE A ee
cer EE a oe
eg
mann
rn,
©) Taking areal ARV ups | CARY gs har e plo rei Doma ao
a Kae menes ronal Conca mw
Fr upto dat nomatn on he panel rg terco ets
ec cesen and ARV ups Hoosier DO rane AY auge
co cect
2) Nowpelve ılı[ı
D) Pee co
2 E
DIAM orson cans ters on st aora aio tac pov sce
Steet minors ely ind ao ser sepa meas a ala ok
Progetogen ny ll POP) ‘ring peegancy or pompa) the correct and consitert ure ot
Propestoperenyhfecae:depot condoms reconmened effet sone or wr anaercoracepion
Progestogen-onıyImplant (MP) 2 E
conso CATEGORY,
"Seal commen a endot | !=Ihtabn, C= Cotman | CLARIICAMOWEVDENCE
on
we | wpa | vor
bi RiVinfeted ‘Evidence: Five aces sueno,
og
pee = ng
DEE A ee
cer EE a oe
eg
mann
rn,
©) Taking areal ARV ups | CARY gs har e plo rei Doma ao
a Kae menes ronal Conca mw
Fr upto dat nomatn on he panel rg terco ets
ec cesen and ARV ups Hoosier DO rane AY auge
co cect
2) Nowpelve ılı[ı
D) Pee co
2 E
DIAM orson cans ters on st aora aio tac pov sce
Steet minors ely ind ao ser sepa meas a ala ok
NesRHE EE.
Progesogenty Contraception POC) POC donot protect agaist STUHN. Iter I arlk of SV (cu
Progestageety (POP “rng pregnancy or poster) he cect and constr seo
Poe lea Sanne comanda sae wth mer coton
Present mpl (ME)
conomon SATECORT,
“See nésinnl comm tend ot | L= Moon C= Corman | CLARIICAMONENDENCE:
con
COMET
2) History ol gestational disease: 1 [1 | 1 | esiaence: POC hasno adverse tests
on serum Ip levels in women with a
Fistor of gestational dabetes according
HOT smal susie" Lites
tedence is inconsistent regarding the
development nor insulin dependent
(dabetes among users o POC with a
toy of gestational dabetes "="
D) Non vascular disease
TU Norman dependent 2 | 2 | 2 _| Evidence: Among women wih insulin or
rnorsinsn dependent dabetes, ited
mai ependent 2] 2 | 2 jose
{hattnese methods have ite eet on
shorter e longierm diabetes control
Le HDATe levels haemostatic markers
He
©) Nephropathyetinepathy 2 [22
neuropathy
) Other vascular disease 2|2|2
2) Simple gore cs [13
D) Agenten CN ETUI
©) Hypathyrid Lil
DOTE à co wore cornes tung mama arm engine Deel gas
MMI nn most room más Teno enc cotas por, nce
ÉTAT AE EEE wala a
Progesogenty Contraception POC) POC donot protect agaist STUHN. Iter I arlk of SV (cu
Progestageety (POP “rng pregnancy or poster) he cect and constr seo
Poe lea Sanne comanda sae wth mer coton
Present mpl (ME)
conomon SATECORT,
“See nésinnl comm tend ot | L= Moon C= Corman | CLARIICAMONENDENCE:
con
COMET
2) History ol gestational disease: 1 [1 | 1 | esiaence: POC hasno adverse tests
on serum Ip levels in women with a
Fistor of gestational dabetes according
HOT smal susie" Lites
tedence is inconsistent regarding the
development nor insulin dependent
(dabetes among users o POC with a
toy of gestational dabetes "="
D) Non vascular disease
TU Norman dependent 2 | 2 | 2 _| Evidence: Among women wih insulin or
rnorsinsn dependent dabetes, ited
mai ependent 2] 2 | 2 jose
{hattnese methods have ite eet on
shorter e longierm diabetes control
Le HDATe levels haemostatic markers
He
©) Nephropathyetinepathy 2 [22
neuropathy
) Other vascular disease 2|2|2
2) Simple gore cs [13
D) Agenten CN ETUI
©) Hypathyrid Lil
DOTE à co wore cornes tung mama arm engine Deel gas
MMI nn most room más Teno enc cotas por, nce
ÉTAT AE EEE wala a
Progetogenany Contraception POC) POC do nt protect against STVAN teres lk of STI (nen,
Progetogen ny ll POP) ‘ring peegancy or pompa) the correct and consitert ure ot
Propestoperenyhfecae:depot condoms reconmened effet sone or wr anaercoracepion
Iearonprogeteonsactate OMPR) Mathod Mae condoms rec ne sol STM.
Propestoperony plot 1)
‘CONDITION CATEGORY
See ackitional comments at end of | |= Initiation, C = Continuation CLARIFICATION/EVIDENCE
section we | omra | POP
er
IE
Den HH
a HK
= HH
A rr
E ne
nee,
Md: 2 + 3 | encephalopathy or gastrointestinal
=
NOIA an DIE ven men una mm me MATTE a ONT
D 2 a ne sneer a a ica seca pore una
Steet minors ely ind ao ser sepa MANGA a ala ok
Progetogen ny ll POP) ‘ring peegancy or pompa) the correct and consitert ure ot
Propestoperenyhfecae:depot condoms reconmened effet sone or wr anaercoracepion
Iearonprogeteonsactate OMPR) Mathod Mae condoms rec ne sol STM.
Propestoperony plot 1)
‘CONDITION CATEGORY
See ackitional comments at end of | |= Initiation, C = Continuation CLARIFICATION/EVIDENCE
section we | omra | POP
er
IE
Den HH
a HK
= HH
A rr
E ne
nee,
Md: 2 + 3 | encephalopathy or gastrointestinal
=
NOIA an DIE ven men una mm me MATTE a ONT
D 2 a ne sneer a a ica seca pore una
Steet minors ely ind ao ser sepa MANGA a ala ok
Progetogereniy Contraception POC) POC do ot protect against SUM there I arlk of SMV (clung
Progestogerony pil POP ‘tring pregnancy or pospert te caret and Content use of
Pa ea, tina omer laico
gear par (me)
conomon SATECORT,
“See nésinnl comm tend ot | L= Moon C= Corman | CLARIICAMONENDENCE:
con
COMET
2) Benign Evidence: Thee ls ited dret
rence hat homonalcotracepton
(Focal nodular hyperplasia 2 | 2 | 2 |éééesntimenene
( Hepatocelular adenoma 3 | | 3 | progression orregrssion of iver lesions
© meng women with feral nodular
D) Malignant thepatocetar 3 | s | 3 |épenass mos no evidence
carcnoma) ‘eating to use hormonal contraception
by women wth oer ver tumours
EN © | à | 2 | Evidence: Risk tr disease relapse
cdg Cros disease and among women wth IBD using ral
oeatve cali) contraception (mos studies dona
Specty whether ti POP & COC) does.
ro Increase significant fom that or
Thalassoomia D ES
ice cel disen 1 | [1 [Evidence: One systematic review
nets that among women vith
Sickle cel sease, POC use does not
have adverse effects on haematlogcl
parameters aná in seme sues,
proves benefiga wi respect to nica!
Symptoms
Tandon be ators UI DA OS Wa A DO RTH HOOT
MMI nn most meu piper más Teno enc cotas por, nce
ÉTAT AE EEE wala a
Progestogerony pil POP ‘tring pregnancy or pospert te caret and Content use of
Pa ea, tina omer laico
gear par (me)
conomon SATECORT,
“See nésinnl comm tend ot | L= Moon C= Corman | CLARIICAMONENDENCE:
con
COMET
2) Benign Evidence: Thee ls ited dret
rence hat homonalcotracepton
(Focal nodular hyperplasia 2 | 2 | 2 |éééesntimenene
( Hepatocelular adenoma 3 | | 3 | progression orregrssion of iver lesions
© meng women with feral nodular
D) Malignant thepatocetar 3 | s | 3 |épenass mos no evidence
carcnoma) ‘eating to use hormonal contraception
by women wth oer ver tumours
EN © | à | 2 | Evidence: Risk tr disease relapse
cdg Cros disease and among women wth IBD using ral
oeatve cali) contraception (mos studies dona
Specty whether ti POP & COC) does.
ro Increase significant fom that or
Thalassoomia D ES
ice cel disen 1 | [1 [Evidence: One systematic review
nets that among women vith
Sickle cel sease, POC use does not
have adverse effects on haematlogcl
parameters aná in seme sues,
proves benefiga wi respect to nica!
Symptoms
Tandon be ators UI DA OS Wa A DO RTH HOOT
MMI nn most meu piper más Teno enc cotas por, nce
ÉTAT AE EEE wala a
‘CONDITION CATEGORY
Sen ebstonlcanmertsatendot | 1 toon, Canin CCLARIFICATIONEVOENCE
Ea mue [ou | POP
2 | 2 | 2 | cureaton Risk ofCVDi noeasad
ang worsen ana a
arte no dance al POC as associated
sith reduced BMD ot ly facts e
sai erheumato arisen ue of
‘al contactan "= (mos sues dae
ci wether te POP or COC)
Clarion: Wren wih SLE we tan
Incense ax of chasm har carte
‘rote and VTE and he oracion e
2) No aréphosphalpid abodes | 2 | 2 | 2 | és ave
ee 2 | 2 | 2 [anti rdencindetenatmanywnen
‘ith SLE can bo con gend ende
Ver most mind fear art ncn
men conception ==
2 | 2 | 2 cacaos: postive aniphesharis
ars (PL) isnt deso sat
Shainthesbeance of mantesaton ofthe
prosa stones ration
Sfr scale aac, neces
IErecenmended ln portada pertence
STaPL post hight ob. ups
Srecoagar (A) post ele potty
fer artardaipn anodes (Can.
Ba dicton 16) and LAs
InmnegobuinG (90) a hee gene ike
forte vents =
‘See secton on drug interactions wäh hormonal contraception
NOIA an DIE ven ROG una IA me TAT ONT
DE maps aus mol cnc una snr tea sap em pov, ance
Seine mens a soe ma nite neon wen nace ut
Sen ebstonlcanmertsatendot | 1 toon, Canin CCLARIFICATIONEVOENCE
Ea mue [ou | POP
2 | 2 | 2 | cureaton Risk ofCVDi noeasad
ang worsen ana a
arte no dance al POC as associated
sith reduced BMD ot ly facts e
sai erheumato arisen ue of
‘al contactan "= (mos sues dae
ci wether te POP or COC)
Clarion: Wren wih SLE we tan
Incense ax of chasm har carte
‘rote and VTE and he oracion e
2) No aréphosphalpid abodes | 2 | 2 | 2 | és ave
ee 2 | 2 | 2 [anti rdencindetenatmanywnen
‘ith SLE can bo con gend ende
Ver most mind fear art ncn
men conception ==
2 | 2 | 2 cacaos: postive aniphesharis
ars (PL) isnt deso sat
Shainthesbeance of mantesaton ofthe
prosa stones ration
Sfr scale aac, neces
IErecenmended ln portada pertence
STaPL post hight ob. ups
Srecoagar (A) post ele potty
fer artardaipn anodes (Can.
Ba dicton 16) and LAs
InmnegobuinG (90) a hee gene ike
forte vents =
‘See secton on drug interactions wäh hormonal contraception
NOIA an DIE ven ROG una IA me TAT ONT
DE maps aus mol cnc una snr tea sap em pov, ance
Seine mens a soe ma nite neon wen nace ut
TER
Additional Comments
HYPERTENSION
A single reading of BP level is not sufficient to classify a woman as hypertensive. I elevated
the BP should be reassessed at the end of the consultation. If BP is increased, it should be re-
assessed and monitored according to current guidelines,
CARDIOVASCULAR DISEASE, ISCHAEMIC HEART DISEASE AND STROKE
There is concer regarding hypoestrogenio effects and reduced HOL levels among users of
DMPA. However, there is little concern about these effects with regard to POP or IMP. The
effects of DMPA may persist for some time after discontinuation.
VALVULAR AND CONGENITAL HEART DISEASE, CARDIOMYOPATHY AND CARDIAC
ARRHYTHMIAS.
‘Stasis, endothelial injury and hyperviscosity (Virchows trad) increase the risk of clot
formation, Impaired cardiac function and/or dilated heart chambers or arıhythmia increase the
tisk of stasis. Closure of a cardiac defect within the last 6 months or presence of a mechanical
heart valve increase the risk of thrombus formation. Cyanotic defects are associated with
hyperviscosity because of erythrocytosis.
UNEXPLAINED VAGINAL BLEEDING
POC may cause irregular bleeding patterns which may mask symptoms of underlying
pathology. The effects of DMPA may persist for some time after discontinuation.
CERVICAL, ENDOMETRIAL AND OVARIAN CANCER
While awaiting treatment, women with gynaecological cancers may use POC since the period
‘of waiting is ikely tobe brief and pregnancy would be contraindicated
CERVICAL CANCER
There is some theoretical concern that POC use could affect prognosis of cervical cancer.
HIV INFECTION
Women at high risk of HIV infection should be informed that progestogen-only
injectables may or may not increase their risk of HIV acquistion, Women and couples
at high risk of HIV acquisition considering DMPA should also be informed about
and have access to HIV preventive measures, including male and female condoms.
Women with HIV infection often have co-morbidties that may influence their choice of
contraception.
Additional Comments
HYPERTENSION
A single reading of BP level is not sufficient to classify a woman as hypertensive. I elevated
the BP should be reassessed at the end of the consultation. If BP is increased, it should be re-
assessed and monitored according to current guidelines,
CARDIOVASCULAR DISEASE, ISCHAEMIC HEART DISEASE AND STROKE
There is concer regarding hypoestrogenio effects and reduced HOL levels among users of
DMPA. However, there is little concern about these effects with regard to POP or IMP. The
effects of DMPA may persist for some time after discontinuation.
VALVULAR AND CONGENITAL HEART DISEASE, CARDIOMYOPATHY AND CARDIAC
ARRHYTHMIAS.
‘Stasis, endothelial injury and hyperviscosity (Virchows trad) increase the risk of clot
formation, Impaired cardiac function and/or dilated heart chambers or arıhythmia increase the
tisk of stasis. Closure of a cardiac defect within the last 6 months or presence of a mechanical
heart valve increase the risk of thrombus formation. Cyanotic defects are associated with
hyperviscosity because of erythrocytosis.
UNEXPLAINED VAGINAL BLEEDING
POC may cause irregular bleeding patterns which may mask symptoms of underlying
pathology. The effects of DMPA may persist for some time after discontinuation.
CERVICAL, ENDOMETRIAL AND OVARIAN CANCER
While awaiting treatment, women with gynaecological cancers may use POC since the period
‘of waiting is ikely tobe brief and pregnancy would be contraindicated
CERVICAL CANCER
There is some theoretical concern that POC use could affect prognosis of cervical cancer.
HIV INFECTION
Women at high risk of HIV infection should be informed that progestogen-only
injectables may or may not increase their risk of HIV acquistion, Women and couples
at high risk of HIV acquisition considering DMPA should also be informed about
and have access to HIV preventive measures, including male and female condoms.
Women with HIV infection often have co-morbidties that may influence their choice of
contraception.
DIABETES
‘There is concern regarding hypoestrogenic effects and reduced HDL levels among users of
DMPA. The effects of DMPA may persist for some time after discontinuation.
HISTORY OF CHOLESTASIS
‘Theoretically, a history of COC-related cholestasis may predict subsequent cholestasis with
POC use,
VIRAL HEPATITIS AND CIRRHOSIS.
POC are metabolised by the liver and their use may adversely affect women whose liver
function is compromised. This concer is similar to, but less than, that with COC.
LIVER TUMOURS,
Progestogens are metabolised by the liver and use may adversely affect women whose liver
function is compromised,
INFLAMMATORY BOWEL DISEASE (IBD)
Risk of VTE may increase if a woman is unwell, bed-bound or undergoing acute surgery, or
with major surgery and prolonged immobilisation, Under these circumstances, POC can be
‘continued
(Oral methods may be less reliable i there is significant malabsorption or small bowel resection
(Particularly with Crohn's disease). Oral methods are unaffected by colectomy and ileostomy.
DRUG INTERACTIONS
Generally, the safety of using POC is unaffected. Nevertheless, use of liver enzyme inducers
may reduce contraception efficacy of POP and IMP, increasing the risk of an unintended
pregnancy DMPA is unaffected by liver enzyme inducing drugs and injection intervals need
not be reduced. Contraception choice may depend on the likely duration of use of concurrent
medications and need for additional or alternative methods
‘There is concern regarding hypoestrogenic effects and reduced HDL levels among users of
DMPA. The effects of DMPA may persist for some time after discontinuation.
HISTORY OF CHOLESTASIS
‘Theoretically, a history of COC-related cholestasis may predict subsequent cholestasis with
POC use,
VIRAL HEPATITIS AND CIRRHOSIS.
POC are metabolised by the liver and their use may adversely affect women whose liver
function is compromised. This concer is similar to, but less than, that with COC.
LIVER TUMOURS,
Progestogens are metabolised by the liver and use may adversely affect women whose liver
function is compromised,
INFLAMMATORY BOWEL DISEASE (IBD)
Risk of VTE may increase if a woman is unwell, bed-bound or undergoing acute surgery, or
with major surgery and prolonged immobilisation, Under these circumstances, POC can be
‘continued
(Oral methods may be less reliable i there is significant malabsorption or small bowel resection
(Particularly with Crohn's disease). Oral methods are unaffected by colectomy and ileostomy.
DRUG INTERACTIONS
Generally, the safety of using POC is unaffected. Nevertheless, use of liver enzyme inducers
may reduce contraception efficacy of POP and IMP, increasing the risk of an unintended
pregnancy DMPA is unaffected by liver enzyme inducing drugs and injection intervals need
not be reduced. Contraception choice may depend on the likely duration of use of concurrent
medications and need for additional or alternative methods
TER
Combined Hormonal Contraception (CHC)
The section on combined hormonal contraception (CHC) includes the folowing types:
+ Combined oral contraception (COC)
+ Combined contraception transdermal patches
+ Combined contraception vaginal ings.
FSRH guidance on CHC’ is available on the FSRH website
‘Combined oral contraception (COC)
The recommendations in the UKMEC refer to low-dose combined oral contraception (COC)
containing <35 yg ethinyestradiol (EE) combined with a progestogen. Data relating to newer
COC containing estradiol are very limited. Currently, UKMEC recommendations for these
preparations are as for EE-containing COC. Recommendations in the UKMEC are the same
for all COC formulations, respective oftheir progestogen content
Venous thromboembolism (VTE) is rare among women of reproductive age. All COC
are associated with an increased risk for VTE compared to non-use. Studies have found
differences in risk for VTE associated with COC containing different progestogens. Current
evidence suggests that COC containing LNG, NET and norgestimate are associated with the
lowest risk, The absolute differences, however, are very small?
Combined contraceptive transdermal patch and vaginal rings
The combined contraceptive patch and ring are relatively new contraception methods. Limited
information is available on the short and long-term safety of these methods among women
with specific medical conditions. Most of the available studies received support from the
‘manufacturers of these methods.
After reviewing the available limited evidence, the UKMEC GDG considers the evidence
available for COC to be applicable to the combined contraceptive patch and ring, and
therefore should have the same categories as COC. This is presented in the UKMEC tables as
the method ‘CHC:
Combined Hormonal Contraception (CHC)
The section on combined hormonal contraception (CHC) includes the folowing types:
+ Combined oral contraception (COC)
+ Combined contraception transdermal patches
+ Combined contraception vaginal ings.
FSRH guidance on CHC’ is available on the FSRH website
‘Combined oral contraception (COC)
The recommendations in the UKMEC refer to low-dose combined oral contraception (COC)
containing <35 yg ethinyestradiol (EE) combined with a progestogen. Data relating to newer
COC containing estradiol are very limited. Currently, UKMEC recommendations for these
preparations are as for EE-containing COC. Recommendations in the UKMEC are the same
for all COC formulations, respective oftheir progestogen content
Venous thromboembolism (VTE) is rare among women of reproductive age. All COC
are associated with an increased risk for VTE compared to non-use. Studies have found
differences in risk for VTE associated with COC containing different progestogens. Current
evidence suggests that COC containing LNG, NET and norgestimate are associated with the
lowest risk, The absolute differences, however, are very small?
Combined contraceptive transdermal patch and vaginal rings
The combined contraceptive patch and ring are relatively new contraception methods. Limited
information is available on the short and long-term safety of these methods among women
with specific medical conditions. Most of the available studies received support from the
‘manufacturers of these methods.
After reviewing the available limited evidence, the UKMEC GDG considers the evidence
available for COC to be applicable to the combined contraceptive patch and ring, and
therefore should have the same categories as COC. This is presented in the UKMEC tables as
the method ‘CHC:
enn aon Corte ee)
conte or concept coc)
ori ta nara pach
vagina
on store and ton
AAA
da on ls ropa ccoo ur sa condos
NA | Clarification: There is no known harm tothe
woman, the course ol pregnancy or ne fetus if
(CH Is accidentally used during pregnancy.
2) Menarcheto <40 years ï
D) 240 years 2 ‘larfcation: Guidance rom the FSRH support
use of CHC up to age 50 yearsifthere are no
‘medical convaindeationsto use"
2) Naliparcus 7
D) Parous 1
2) Dto < weeks
BEET
Evidence: One systematic review reports that
the impact of COC on Breasteesingduation and
success 1 inconsistent. Resuts are cofiing
D) 26 weeks to <Bmonthe
(Grimaiybreastteing)
{whether eal intation of COC ais infant
‘utcames, but generally fnd no negative impact
2) 28 months
‘on nant uteomes wih ater Intlahen of COC.”
NOIA an DIE ven ROG una IA me TAT ONT
DE maps aus mol cnc una snr tea sap em pov, ance
Steet minors ely ind ao ser sepa meas a ala ok
conte or concept coc)
ori ta nara pach
vagina
on store and ton
AAA
da on ls ropa ccoo ur sa condos
NA | Clarification: There is no known harm tothe
woman, the course ol pregnancy or ne fetus if
(CH Is accidentally used during pregnancy.
2) Menarcheto <40 years ï
D) 240 years 2 ‘larfcation: Guidance rom the FSRH support
use of CHC up to age 50 yearsifthere are no
‘medical convaindeationsto use"
2) Naliparcus 7
D) Parous 1
2) Dto < weeks
BEET
Evidence: One systematic review reports that
the impact of COC on Breasteesingduation and
success 1 inconsistent. Resuts are cofiing
D) 26 weeks to <Bmonthe
(Grimaiybreastteing)
{whether eal intation of COC ais infant
‘utcames, but generally fnd no negative impact
2) 28 months
‘on nant uteomes wih ater Intlahen of COC.”
NOIA an DIE ven ROG una IA me TAT ONT
DE maps aus mol cnc una snr tea sap em pov, ance
Steet minors ely ind ao ser sepa meas a ala ok
SR
tek of STH Frig rg
para) a conc and mir ane const
ed caer sons ow anne conrscepaon nod Nae condo
Sa gra
A | fan ea sea te ma COC en, Howe
Cc | Ian so atout ame cece
TA
per fn rates wan) taification: This incas any bis, including
bt fom 24 weeks gestation,
— sits fom 24 weeks gestation
TE a Clarification: inthe presence of ther risk
LR EAU factors fer VTE. uch as mob, ranstuson
(Wout eer ik factors 3 at dlvery, BM 230 gin” postpartum
D) 3to<Gweeks
(Wh oer ak actor or VTE:
(Wout eer rik factors
©) BB weeks
Faementage immediately postenesarean
ele, pre-eclampsia or smoking use of CHC
may pose an addonal increased isk VTE
Evidence VTE risks elevated during pregnancy
and the postpartum period; this isk ls most
proncunced inthe rt 3 weeks ater delvery,
Gesiring to near baselne levels by 42 days
postpartum. Use ef CHC. which nerease
the a of VTE in women ofreproaucive age,
may pose an addhiona isk used during this
time? Risk of pregnancy during the est 21 days
postpartum is very low, but increases ater hat
me in non-reasteeding women: ovulation
etre frst menses commen =“
Tandon be ators UI DA OS Wa A DO RTH HOOT
‘irate ma rt econmenara ns une A menos ae Nt tae ak
tek of STH Frig rg
para) a conc and mir ane const
ed caer sons ow anne conrscepaon nod Nae condo
Sa gra
A | fan ea sea te ma COC en, Howe
Cc | Ian so atout ame cece
TA
per fn rates wan) taification: This incas any bis, including
bt fom 24 weeks gestation,
— sits fom 24 weeks gestation
TE a Clarification: inthe presence of ther risk
LR EAU factors fer VTE. uch as mob, ranstuson
(Wout eer ik factors 3 at dlvery, BM 230 gin” postpartum
D) 3to<Gweeks
(Wh oer ak actor or VTE:
(Wout eer rik factors
©) BB weeks
Faementage immediately postenesarean
ele, pre-eclampsia or smoking use of CHC
may pose an addonal increased isk VTE
Evidence VTE risks elevated during pregnancy
and the postpartum period; this isk ls most
proncunced inthe rt 3 weeks ater delvery,
Gesiring to near baselne levels by 42 days
postpartum. Use ef CHC. which nerease
the a of VTE in women ofreproaucive age,
may pose an addhiona isk used during this
time? Risk of pregnancy during the est 21 days
postpartum is very low, but increases ater hat
me in non-reasteeding women: ovulation
etre frst menses commen =“
Tandon be ators UI DA OS Wa A DO RTH HOOT
‘irate ma rt econmenara ns une A menos ae Nt tae ak
‘ContinedHomonalcontacepton|CHC) CHE donot protect agas STO ar aot STV cng dng
ET EA
ee a
e _, sm
...._
Ea
A E | pantera en mms
lettin, | nee
E
A
Fea ines ne ee
D) Second inet 1
Clarification: CHC maybe stated immediatly
1 postaborien
©) Post-aboton sep
Evidence: Women who sta taking COC
Immediately ater ist rmester medical or
Surgical abortion do not experience more side
fects, adverse vaginal bleeding outcomes
Sr cnicaly signifeant changes in coagulaton
parameters compared wih women who use a
placebo, an UD, anon-hormenaleoiraception
melhod or delayed COC tation." Lined
evidence on women using the cenraceptive
fing immediatly ater estrimester medica or
“surgical abortion suggests no serious adverse
‘vents and no infection relates to use ofthe
ontacepive rng dung tree cytes of folow-up
postabotien.”
Pest ectopic pregnancy 1
History of pie surgery 7
NOIA an DIE ven ROG una IA me TAT ONT
MMMM orson cans ters on st aora aio tac pov sce
Steet minors ely ind ao ser sepa meas a ala ok
ET EA
ee a
e _, sm
...._
Ea
A E | pantera en mms
lettin, | nee
E
A
Fea ines ne ee
D) Second inet 1
Clarification: CHC maybe stated immediatly
1 postaborien
©) Post-aboton sep
Evidence: Women who sta taking COC
Immediately ater ist rmester medical or
Surgical abortion do not experience more side
fects, adverse vaginal bleeding outcomes
Sr cnicaly signifeant changes in coagulaton
parameters compared wih women who use a
placebo, an UD, anon-hormenaleoiraception
melhod or delayed COC tation." Lined
evidence on women using the cenraceptive
fing immediatly ater estrimester medica or
“surgical abortion suggests no serious adverse
‘vents and no infection relates to use ofthe
ontacepive rng dung tree cytes of folow-up
postabotien.”
Pest ectopic pregnancy 1
History of pie surgery 7
NOIA an DIE ven ROG una IA me TAT ONT
MMMM orson cans ters on st aora aio tac pov sce
Steet minors ely ind ao ser sepa meas a ala ok
SR
Contined Hormona Canracptan CC]. CHE donot pole aginst SIMIL heels rs ef STH ung ng
cats rene post he cect ad consiste no cord
ed caer sons ow anne conrscepaon nod Nae condo
Corn ccoo teeta one
Sa gra
A | fan ea sea te ma COC en, Howe
nang
2) Age <25 years 2 ‘Clarification: UKMEG curenty doesnot include
2 Use of cigares, as Ass associated with ther
bd teil use are not yet established.
(215 digarettesta 3
Evidence: COC users who smoke ae tan
(W215 garetesiday y increased ik of CVD, especialy MI compared
Ta ne mama Oe o ‘wa nose ho donot smoke, Studies alo show
un Hin an inerenend isk of win an neresing num
(i Stopped smoking 21 year 2 of ogareties smoked per day
“The 35 year age ct ois identified because
any excess motaltyassciated wih smoking
becomes apparent Hom this age.” The monalty
rate om all causes including cancer) decreases
tothat ofa nen-smeker whi 20 years of
‘smoking cessation. The CVD risk associated with
Enokng decreases within 110 years of scking
cessation"
5 Clarification: The absolute isk of TE in women
CET 2 reproduce ages low. Te relative sk of
D) BM 235 km 3 VTE increases wth CHC use. Nevertheless, the
absolue risk of VTE in CHC uses il on
Evidence: The risk of VIE rises as Blincreases
‘oer 30 and ees fer win EMI over 35.
Ua of CHC rales is nerent increased
father" Limited evidence suggests trat
‘bese women who use COC do not have a
higher rik acute Ml e stroke than obese non
or: POE
— A EE ear
Contined Hormona Canracptan CC]. CHE donot pole aginst SIMIL heels rs ef STH ung ng
cats rene post he cect ad consiste no cord
ed caer sons ow anne conrscepaon nod Nae condo
Corn ccoo teeta one
Sa gra
A | fan ea sea te ma COC en, Howe
nang
2) Age <25 years 2 ‘Clarification: UKMEG curenty doesnot include
2 Use of cigares, as Ass associated with ther
bd teil use are not yet established.
(215 digarettesta 3
Evidence: COC users who smoke ae tan
(W215 garetesiday y increased ik of CVD, especialy MI compared
Ta ne mama Oe o ‘wa nose ho donot smoke, Studies alo show
un Hin an inerenend isk of win an neresing num
(i Stopped smoking 21 year 2 of ogareties smoked per day
“The 35 year age ct ois identified because
any excess motaltyassciated wih smoking
becomes apparent Hom this age.” The monalty
rate om all causes including cancer) decreases
tothat ofa nen-smeker whi 20 years of
‘smoking cessation. The CVD risk associated with
Enokng decreases within 110 years of scking
cessation"
5 Clarification: The absolute isk of TE in women
CET 2 reproduce ages low. Te relative sk of
D) BM 235 km 3 VTE increases wth CHC use. Nevertheless, the
absolue risk of VTE in CHC uses il on
Evidence: The risk of VIE rises as Blincreases
‘oer 30 and ees fer win EMI over 35.
Ua of CHC rales is nerent increased
father" Limited evidence suggests trat
‘bese women who use COC do not have a
higher rik acute Ml e stroke than obese non
or: POE
— A EE ear
‘ContinedHomonalcontacepton|CHC) CHE donot protect agas STO ar aot STV cng dng
seach ete ‘ney rpenpahm he ames an conc sno condo
Pme clr sso wa enter concep abode onde
Cort or concept [COC] reta er TN
ori ta sa ra pach
vagina
(Comment: URMEC categories relat o satay
2) th BM <30kgm 4 ‘of use. Barat surgca procedures invling
1) With EM 23034 kin” 2 a malabserptve component have Be potent
to eerease ra contraception efcteness,
©) With BM 235 kgm 3 perhaps further decreased by postoperative
complications suchas long-term darhosa andlor
vont
Evidence: Lined evidence demonstrates no
‘ubstantal decrease in efleciveness of oral
contraception among women who undergo
Taparoscopi placement ofan ajustable
{gastic band or Blpancreai diversion“
However, evidence fom pharmacokinelc studies
report config rest o oral contraception
‘fectveness among wemen whe undergo a
Isunoteal bypass
2) Complicated: gra faire (acute 3 ‘Clarification: Women with Bud Char syndrome
or cent) rejcton, cardiac should net use CHC because ofthe increased sk
logra vascuopathy ftrembosis and grat rjecin.
D) Uneemplicates 2
Evidence: One study reports discontinuation
ef COC use in 226 8%) women as a result of
‘serous medical complcatons, and ane case
‘eyo recounts a woman developing cholet
associated wth high-dose COC use
cu Ey
DIAM orson cans ters on st aora aio tac pov sce
Steet minors ely ind ao ser sepa meas a ala ok
seach ete ‘ney rpenpahm he ames an conc sno condo
Pme clr sso wa enter concep abode onde
Cort or concept [COC] reta er TN
ori ta sa ra pach
vagina
(Comment: URMEC categories relat o satay
2) th BM <30kgm 4 ‘of use. Barat surgca procedures invling
1) With EM 23034 kin” 2 a malabserptve component have Be potent
to eerease ra contraception efcteness,
©) With BM 235 kgm 3 perhaps further decreased by postoperative
complications suchas long-term darhosa andlor
vont
Evidence: Lined evidence demonstrates no
‘ubstantal decrease in efleciveness of oral
contraception among women who undergo
Taparoscopi placement ofan ajustable
{gastic band or Blpancreai diversion“
However, evidence fom pharmacokinelc studies
report config rest o oral contraception
‘fectveness among wemen whe undergo a
Isunoteal bypass
2) Complicated: gra faire (acute 3 ‘Clarification: Women with Bud Char syndrome
or cent) rejcton, cardiac should net use CHC because ofthe increased sk
logra vascuopathy ftrembosis and grat rjecin.
D) Uneemplicates 2
Evidence: One study reports discontinuation
ef COC use in 226 8%) women as a result of
‘serous medical complcatons, and ane case
‘eyo recounts a woman developing cholet
associated wth high-dose COC use
cu Ey
DIAM orson cans ters on st aora aio tac pov sce
Steet minors ely ind ao ser sepa meas a ala ok
SR
Contined Hormona Canracptan CC]. CHE donot pole aginst SIMIL heels rs ef STH ung ng
cats pregnancy pou he Comecnd coat sot onda
ed caer sons ow anne conrscepaon nod Nae condo
corn on Con PARCS EST
Sa gra
A | fan ea sea te ma COC en, Howe
nang
factors for CVD (such 3 Clafiation: When a woman has mutile
ng, diabetes, hypertension, major ak factors, any of which alone would
‘hbstantyineease he ik of CVD, use of
CHE may increase her sto an unacoeptable
level However, a simple addon e categories for
tiple isk factors not intended; fr example
combination of two ak factors assigned a
Cslagory 2may not necessary warrant a higher
om,
nn Clarification: For al categories of hypertensic
2) Adequately controlled > ‘dassifications are based on the assumption that
EE ar Can name
7) oia Toad Pn ed
ans Sonny
Paste omar 3 | saitaion Vin adi enter
aa A mn ende we rd sola na
ETA res ue wen Ala
LEE Se er en voca
conroled and menitred hypertension should be
reduced isk of acute M and stoke compared
ah untreated hypertensive CHC users
‘Antihypertensive ferapy may be intate when
the BP is consisenty 180100 mmHg or igher 2
Evidence Among women wih hypertension.
(COC uses are at an increased nak of rot
Beute Ml and peripheral arterial disease compared
ah nonusers" Discontinuation of
{COC in women wih hypertension may improve
EP coma
2 E
— A EE ear
Contined Hormona Canracptan CC]. CHE donot pole aginst SIMIL heels rs ef STH ung ng
cats pregnancy pou he Comecnd coat sot onda
ed caer sons ow anne conrscepaon nod Nae condo
corn on Con PARCS EST
Sa gra
A | fan ea sea te ma COC en, Howe
nang
factors for CVD (such 3 Clafiation: When a woman has mutile
ng, diabetes, hypertension, major ak factors, any of which alone would
‘hbstantyineease he ik of CVD, use of
CHE may increase her sto an unacoeptable
level However, a simple addon e categories for
tiple isk factors not intended; fr example
combination of two ak factors assigned a
Cslagory 2may not necessary warrant a higher
om,
nn Clarification: For al categories of hypertensic
2) Adequately controlled > ‘dassifications are based on the assumption that
EE ar Can name
7) oia Toad Pn ed
ans Sonny
Paste omar 3 | saitaion Vin adi enter
aa A mn ende we rd sola na
ETA res ue wen Ala
LEE Se er en voca
conroled and menitred hypertension should be
reduced isk of acute M and stoke compared
ah untreated hypertensive CHC users
‘Antihypertensive ferapy may be intate when
the BP is consisenty 180100 mmHg or igher 2
Evidence Among women wih hypertension.
(COC uses are at an increased nak of rot
Beute Ml and peripheral arterial disease compared
ah nonusers" Discontinuation of
{COC in women wih hypertension may improve
EP coma
2 E
— A EE ear
‘ContinedHomonalcontacepton|CHC) CHE donot protect agas STO ar aot STV cng dng
seach ener nme) pen Seca conte etc
ersten eier cape mates condos
Cort or concept [COC] reta er TN
ori ta sa ra pach
vagina
“Sevsstuateonmertratendcteeton | néon Ms atan arto coe en. Het,
cannon | Ms lan ase pete use decora
panna
©) Vascular disease 7) “laifictions This includes coronary heart
disease presenting wih angina, peripheral
‘vascular disease presentng wth inemiten
{laualcaton, hypecensive retinopathy and TIA
History of ‘Clarification: Where eurent BP measurable
Pregnancy 2 and normal
Evidence: COC users vih a history o gh BP in
pregnancy have an increased sk ofMl aná VTE,
compared vith COC users uno de nt have a
stay ofhigh BP during pregnancy The absolute
fake of sete Mi ana VTE inti population
female sal"
‘Current and history of ischaomic n
heart disease"
‘Stroke (str of cerebrovascular zy
accident ncucng TIA)
Known dyslpidaomias. 2 Clarficatons Routine screening er these genetic
rues nat co efectve
Increased levels total cholesterol, LOL and
genden, as wellas decreased eves of
HDL, are known rk factors CVD. Women
known, severe, geneti pi isrders are
ata much higher fete tsk fr CVD and may
Vara futher cnica consideration
cocos ca
DIAM orson cans ters on st aora aio tac pov sce
Steet minors ely ind ao ser sepa meas a ala ok
seach ener nme) pen Seca conte etc
ersten eier cape mates condos
Cort or concept [COC] reta er TN
ori ta sa ra pach
vagina
“Sevsstuateonmertratendcteeton | néon Ms atan arto coe en. Het,
cannon | Ms lan ase pete use decora
panna
©) Vascular disease 7) “laifictions This includes coronary heart
disease presenting wih angina, peripheral
‘vascular disease presentng wth inemiten
{laualcaton, hypecensive retinopathy and TIA
History of ‘Clarification: Where eurent BP measurable
Pregnancy 2 and normal
Evidence: COC users vih a history o gh BP in
pregnancy have an increased sk ofMl aná VTE,
compared vith COC users uno de nt have a
stay ofhigh BP during pregnancy The absolute
fake of sete Mi ana VTE inti population
female sal"
‘Current and history of ischaomic n
heart disease"
‘Stroke (str of cerebrovascular zy
accident ncucng TIA)
Known dyslpidaomias. 2 Clarficatons Routine screening er these genetic
rues nat co efectve
Increased levels total cholesterol, LOL and
genden, as wellas decreased eves of
HDL, are known rk factors CVD. Women
known, severe, geneti pi isrders are
ata much higher fete tsk fr CVD and may
Vara futher cnica consideration
cocos ca
DIAM orson cans ters on st aora aio tac pov sce
Steet minors ely ind ao ser sepa meas a ala ok
ACTE
Conti Homona antacapton( cH} hc gut TIME eis rra TUR cg ng
‘itches para) a conc and mir ane const
ed caer sons ow anne conrscepaon nod Nae condo
Corn ccoo teeta one
Sa gra
A | fan ea sea te ma COC en, Howe
nang
2) History of VTE E] Ctaficaion: VTE includes DVT and PE
D} Current VTE (en aniecaguants) + ‘On anticoagulants: Women on anicoaguant
therapy area isk for gynacclogeal
complications of therapy, such as haemontagie
varian cysts and HMB, Hormonal contraception
methods can be of beneft im prevening r rating
these complications. When a contraception
methods used as a therapy, rather than soley to
Prevent pregrancy the iekbeneft aio may afer
And shoul be considered on acasoby-case
bass.
©) Family isto of VTE ‘Family history of VIE: May aer eincansto
amer who may have anineeased sk bt
Fra degree eave age D Sone carnet derby wih certainty an under ing
<45 years Evombopiila
(0 Fist degre reine age 2
245 years
© Major suey ‘por and minor surgery CHG shal pete
carino und adequate aerate ragen
Win praonges + agents made) dad Dre maj cette
Immobisaton os 030 minder dal) an srg onthe
Without prolonged 2 a]
Imcoizaion ‘tise? west bran. POC may
CES a ‘tarsi, abe Whe Scoot of
immobilisation {ac ne posse (eg abe aura sit patent
9 immobity (unrelated to rs dite fon lective procedures slung CHO,
Se ee rss emo le tho steer ght hepa
‘rd Dada compression han sed
cn rien tama np upton”
Santa e e tacon o iso ug
(ron he hen concept
debian Ines)
or: POE
— A EE ear
Conti Homona antacapton( cH} hc gut TIME eis rra TUR cg ng
‘itches para) a conc and mir ane const
ed caer sons ow anne conrscepaon nod Nae condo
Corn ccoo teeta one
Sa gra
A | fan ea sea te ma COC en, Howe
nang
2) History of VTE E] Ctaficaion: VTE includes DVT and PE
D} Current VTE (en aniecaguants) + ‘On anticoagulants: Women on anicoaguant
therapy area isk for gynacclogeal
complications of therapy, such as haemontagie
varian cysts and HMB, Hormonal contraception
methods can be of beneft im prevening r rating
these complications. When a contraception
methods used as a therapy, rather than soley to
Prevent pregrancy the iekbeneft aio may afer
And shoul be considered on acasoby-case
bass.
©) Family isto of VTE ‘Family history of VIE: May aer eincansto
amer who may have anineeased sk bt
Fra degree eave age D Sone carnet derby wih certainty an under ing
<45 years Evombopiila
(0 Fist degre reine age 2
245 years
© Major suey ‘por and minor surgery CHG shal pete
carino und adequate aerate ragen
Win praonges + agents made) dad Dre maj cette
Immobisaton os 030 minder dal) an srg onthe
Without prolonged 2 a]
Imcoizaion ‘tise? west bran. POC may
CES a ‘tarsi, abe Whe Scoot of
immobilisation {ac ne posse (eg abe aura sit patent
9 immobity (unrelated to rs dite fon lective procedures slung CHO,
Se ee rss emo le tho steer ght hepa
‘rd Dada compression han sed
cn rien tama np upton”
Santa e e tacon o iso ug
(ron he hen concept
debian Ines)
or: POE
— A EE ear
‘ContinedHomonalcontacepton|CHC) CHE donot protect agas STO ar aot STV cng dng
Sarre ‘ney rpenpahm care an conc ao! condo
Pme clr sso wa enter coran abode onde
Cort or concept [COC] reta er TN
arenes cocos tare pt
EE
sm astrtconmanselendetsectn | Lima Mos vce rte ets °C OC Hon
conan | halo ate pedi no coran
CTA
Varicose veins 7 Evidence, One zu Cost
” NE ES
Brent ar COC nen corpureaw no
ar
D) Supera venous Inomboss 2 en Sper neu vont mayb
Mo
EAS
Known thrombogenic mutations n ‘Clarification: Routine screening fe these genetic
(09, facto V Leiden. protrombin multionsiena cost efec 90
Antihrembin defencis) Evidence: Among women vih tnrombogenie
mutations, COC users have a two-to weni
iger ik of thrombosis han non-users"
3) Uncemplcates 2 Center Un nn cause comes
D) Complicated (eg. pulmonary + Kim woran anime on es oso ream
hypertension, history of subacute Re et orn In sat Sra
Bacteria endacarats) SERRES
‘peg annee ea pay
page sie Ci ftw aso conte
2 E
DIAM orson cans ters on st aora aio tac pov sce
Steet minors ely ind ao ser sepa meas a ala ok
Sarre ‘ney rpenpahm care an conc ao! condo
Pme clr sso wa enter coran abode onde
Cort or concept [COC] reta er TN
arenes cocos tare pt
EE
sm astrtconmanselendetsectn | Lima Mos vce rte ets °C OC Hon
conan | halo ate pedi no coran
CTA
Varicose veins 7 Evidence, One zu Cost
” NE ES
Brent ar COC nen corpureaw no
ar
D) Supera venous Inomboss 2 en Sper neu vont mayb
Mo
EAS
Known thrombogenic mutations n ‘Clarification: Routine screening fe these genetic
(09, facto V Leiden. protrombin multionsiena cost efec 90
Antihrembin defencis) Evidence: Among women vih tnrombogenie
mutations, COC users have a two-to weni
iger ik of thrombosis han non-users"
3) Uncemplcates 2 Center Un nn cause comes
D) Complicated (eg. pulmonary + Kim woran anime on es oso ream
hypertension, history of subacute Re et orn In sat Sra
Bacteria endacarats) SERRES
‘peg annee ea pay
page sie Ci ftw aso conte
2 E
DIAM orson cans ters on st aora aio tac pov sce
Steet minors ely ind ao ser sepa meas a ala ok
SR
Conti Homena Cantacepion GH]. CHE donot proc agunt SIMIL ao rte STH Inu tg
pre
ed caer sons ow anne conrscepaon nod Nae condo
Sa gra
2) Normal eardiae function 2
») Impares carga function 4
y ma simon cae
2) Aral lation
) Known ong QT syndrome
2) Nen-migrainous (mil or severe)
D) Migraine without aura, at any age
2
©} Migraine with aura at any ape 4
©) History (25 years ago of migraine 3
sth ara, any age
Clarification: Headache sa common condaion
affecting women of reproducive age
Evidence: Among women wth migraine, women
‘wo leo have aura area a higher ik of stroke
than those without aura" Women wth a
story efmigraine who use COC are about two to
‘our mes as Bel o have an ischaemic stoke as
non-asers win aistory ol migraine 2
Ciassifeaton depends on making an accurate
diagnosis of those severe headaches hat are
migraincus and, addition, thse complicated by
Sura!" See adeional resource on dagnosis of
gaines wih or without ura
Iaiopatric itr
ypertr
on)
AAA AA EST TES
Conti Homena Cantacepion GH]. CHE donot proc agunt SIMIL ao rte STH Inu tg
pre
ed caer sons ow anne conrscepaon nod Nae condo
Sa gra
2) Normal eardiae function 2
») Impares carga function 4
y ma simon cae
2) Aral lation
) Known ong QT syndrome
2) Nen-migrainous (mil or severe)
D) Migraine without aura, at any age
2
©} Migraine with aura at any ape 4
©) History (25 years ago of migraine 3
sth ara, any age
Clarification: Headache sa common condaion
affecting women of reproducive age
Evidence: Among women wth migraine, women
‘wo leo have aura area a higher ik of stroke
than those without aura" Women wth a
story efmigraine who use COC are about two to
‘our mes as Bel o have an ischaemic stoke as
non-asers win aistory ol migraine 2
Ciassifeaton depends on making an accurate
diagnosis of those severe headaches hat are
migraincus and, addition, thse complicated by
Sura!" See adeional resource on dagnosis of
gaines wih or without ura
Iaiopatric itr
ypertr
on)
AAA AA EST TES
name end con
os estan avs COC us Ht,
és ost ete cece
CEET
Taking atreplept drugs Certain antelope drugs have ine potential to acne
oavalbily otero hormones in hormonal cotracepten In
_daiton,hrmenal contraception may ae the levels o certain ant-
piepie drugs wth potential adverse et
For upto date information on the potential drug interactions between
hoxmenalcetracepton and an pipi drugs, please rte to the
‘nln drag interaction checker valable on Socke a Ineración
Checker webs"
1 Clarification: The clasifation is based on data
for women wt selected depressive disorders
No data ar avaabe on bipolar isrder or
postpartum depresion
Evidence: COC use doesnot incense
Aepressive smptomsin women vith depression
‘compared to baselne orto nonusers wi.
dépression"
a) Iregular patter without heavy 1 ‘larificaton: Abnomal menstrual bleeding should
raie suspicion ofa sel under cendton
bi Heavy o prolonged bleeding 1
Und shuld be investigated appropriately
(includes regular and regular Evidence: COC are shown tobe an efecto
treatment in heavy mensiral bleeding (HMB) >
2 Clarification: pregnancy or an underyng
palhlogical condition (such as pehie malignancy)
Fe auspected t must be evaluated andthe
alegeryadsted ater evaluation
Tangent ons ven ROG una mm me MAT Orr
DE dm res mol On per on tea sap em prä una
Seine mens a soe ma nite neon wen nace ut
os estan avs COC us Ht,
és ost ete cece
CEET
Taking atreplept drugs Certain antelope drugs have ine potential to acne
oavalbily otero hormones in hormonal cotracepten In
_daiton,hrmenal contraception may ae the levels o certain ant-
piepie drugs wth potential adverse et
For upto date information on the potential drug interactions between
hoxmenalcetracepton and an pipi drugs, please rte to the
‘nln drag interaction checker valable on Socke a Ineración
Checker webs"
1 Clarification: The clasifation is based on data
for women wt selected depressive disorders
No data ar avaabe on bipolar isrder or
postpartum depresion
Evidence: COC use doesnot incense
Aepressive smptomsin women vith depression
‘compared to baselne orto nonusers wi.
dépression"
a) Iregular patter without heavy 1 ‘larificaton: Abnomal menstrual bleeding should
raie suspicion ofa sel under cendton
bi Heavy o prolonged bleeding 1
Und shuld be investigated appropriately
(includes regular and regular Evidence: COC are shown tobe an efecto
treatment in heavy mensiral bleeding (HMB) >
2 Clarification: pregnancy or an underyng
palhlogical condition (such as pehie malignancy)
Fe auspected t must be evaluated andthe
alegeryadsted ater evaluation
Tangent ons ven ROG una mm me MAT Orr
DE dm res mol On per on tea sap em prä una
Seine mens a soe ma nite neon wen nace ut
SR
Contined Hormona Centac@pten(CHC) CHE donot pole agnt STN are ars of STH ung ng
cats Peg pena nin ad on ne
corn on Con ST
Sa gra
Endometriosis" 1
Severe dysmenorthoea y Evidence: Thee i no increases Hak of side
facts win COC use among women th
dyamencefcea compared wah women not using
(COC. Some COC users experience areducton in
pain and teding
Gestational wophoblastic disease Clarification: intudeshydativorm male
(cro) (complete and paria) and gestational
‘rophoblastc neoplasia.
2) Undetetable NG level 1
1) Decreasing HCG leves 1 Evidence Flloving molar pregnancy
medion a vacuaton, the balance of evidence inde COC
tise doesnot nee age the ik of gestational
‘wophoblaste neoplasia, and some COC users
‘experience a more raid regression in PCS
lewis compared ith non-user" Une
‘cadence suggests tha use of OC during
‘Chemotherapeutic treatment does nat signcatly
tete regression or reaimen of gestational
trophoblastic neoplasia compared wi women
‘wh use a nor hormonal contraception method or
[DMPA during chematerapeute treatment
or magnant disease
Cervical stropion* 1
Cervical itraepthail neopl 2 “Evidence: Among women wih persistent HPV
cn) infection, ong em COC use (25 years) may
increase thers ofcarnoma in stu nd invasivo
heat
‘anon be DIU ANS DANNY RAR DE DENTS
NMI nn most oem nd Tent enc coa pr, nce
ÉTAT AE EEE AS
Contined Hormona Centac@pten(CHC) CHE donot pole agnt STN are ars of STH ung ng
cats Peg pena nin ad on ne
corn on Con ST
Sa gra
Endometriosis" 1
Severe dysmenorthoea y Evidence: Thee i no increases Hak of side
facts win COC use among women th
dyamencefcea compared wah women not using
(COC. Some COC users experience areducton in
pain and teding
Gestational wophoblastic disease Clarification: intudeshydativorm male
(cro) (complete and paria) and gestational
‘rophoblastc neoplasia.
2) Undetetable NG level 1
1) Decreasing HCG leves 1 Evidence Flloving molar pregnancy
medion a vacuaton, the balance of evidence inde COC
tise doesnot nee age the ik of gestational
‘wophoblaste neoplasia, and some COC users
‘experience a more raid regression in PCS
lewis compared ith non-user" Une
‘cadence suggests tha use of OC during
‘Chemotherapeutic treatment does nat signcatly
tete regression or reaimen of gestational
trophoblastic neoplasia compared wi women
‘wh use a nor hormonal contraception method or
[DMPA during chematerapeute treatment
or magnant disease
Cervical stropion* 1
Cervical itraepthail neopl 2 “Evidence: Among women wih persistent HPV
cn) infection, ong em COC use (25 years) may
increase thers ofcarnoma in stu nd invasivo
heat
‘anon be DIU ANS DANNY RAR DE DENTS
NMI nn most oem nd Tent enc coa pr, nce
ÉTAT AE EEE AS
‘ContinedHomonalcontacepton|CH) CHE donot protect agas STO ar a STV mg rg
seach ener ‘neyo pepe hears an comi set condoms
‘Steed clr stew snot concep rsd ie onde
Conti or concept (COC) roca er TN
ori ta sa ra pach
vagina
“se stare tentation | néon Ms estan avs COC un. Ht,
coma | salón is yet nl occ
CEET
‘Cereal cancer
2) Awaling treatment 2
Pb) Radical tracheleciony 2
Ciariieation: Brea cancer is ahemone-
en tumour and erofce te prognosis of
‘women wth cnt or pat breast cancer may be
‘fected by hormonal metodo contaceptn,
2) Undiagnosed masshreast
smplèms
D} Benign breast conditions| 1
©) Famiy history ofbreast cancer 1
© Carers ofknoun gene mutations 3 Evidence Women vih inherted breast cancer
‘associated wth brest cancer gene mutations (such as BRCAT and BRCAZ)
(69. BROMIBRCAZ) have a much higher bassline risk of breast cancer
{han women witout these genes. The very ited
‘evidence in is area suggests that he rk of
breast cancer among wemen vith ether a famiy
istry of reas cancer or ith known inherited
breast cancer gene mutation probably nek
modified by he use 81000.
©) Breast cancer Clarification: For a woman wih a itory of
breast cancer, a decision 1 iat hormonal
contraception maybe best made in onsulaton
(@) Current breast cancer a Free
(9) Past breast cancer 3
:
Ovarian cancer 1
2 E
DIAM orson cans ters on st aora aio tac pov sce
Steet minors ely ind ao ser sepa meas a ala ok
seach ener ‘neyo pepe hears an comi set condoms
‘Steed clr stew snot concep rsd ie onde
Conti or concept (COC) roca er TN
ori ta sa ra pach
vagina
“se stare tentation | néon Ms estan avs COC un. Ht,
coma | salón is yet nl occ
CEET
‘Cereal cancer
2) Awaling treatment 2
Pb) Radical tracheleciony 2
Ciariieation: Brea cancer is ahemone-
en tumour and erofce te prognosis of
‘women wth cnt or pat breast cancer may be
‘fected by hormonal metodo contaceptn,
2) Undiagnosed masshreast
smplèms
D} Benign breast conditions| 1
©) Famiy history ofbreast cancer 1
© Carers ofknoun gene mutations 3 Evidence Women vih inherted breast cancer
‘associated wth brest cancer gene mutations (such as BRCAT and BRCAZ)
(69. BROMIBRCAZ) have a much higher bassline risk of breast cancer
{han women witout these genes. The very ited
‘evidence in is area suggests that he rk of
breast cancer among wemen vith ether a famiy
istry of reas cancer or ith known inherited
breast cancer gene mutation probably nek
modified by he use 81000.
©) Breast cancer Clarification: For a woman wih a itory of
breast cancer, a decision 1 iat hormonal
contraception maybe best made in onsulaton
(@) Current breast cancer a Free
(9) Past breast cancer 3
:
Ovarian cancer 1
2 E
DIAM orson cans ters on st aora aio tac pov sce
Steet minors ely ind ao ser sepa meas a ala ok
SR
Conti Homena Cantacepion GH]. CHE donot proc agunt STINT we rte STH cg tg
ar megan
ee, See
ane
non | FEE
—— ;
EE
ne mean
Ea
b) Current PID 1
IIT
AZ 5
en :
me
Er ;
en — —
ES
ace en
EEE
N meat
ren,
en
eer
rouen la manos regoros wpa cin Semen ander tera y specs comacptne pro
Conti Homena Cantacepion GH]. CHE donot proc agunt STINT we rte STH cg tg
ar megan
ee, See
ane
non | FEE
—— ;
EE
ne mean
Ea
b) Current PID 1
IIT
AZ 5
en :
me
Er ;
en — —
ES
ace en
EEE
N meat
ren,
en
eer
rouen la manos regoros wpa cin Semen ander tera y specs comacptne pro
‘ContinedHomonalcontacepton|CH) CHE donot protect agas STO ar a STV mg rg
seach ener ‘neyo pepe hears an comi set condoms
‘Steed clr stew snot concep rsd ie onde
Conti or concept (COC) roca er TN
ori ta sa ra pach
vagina
“se stare tentation | néon Ms estan avs COC un. Ht,
Cannon | Mél ase pic decora
panna
‘Evidence: Lowto-moderate-qualty evidence
a Fah i LV econ 7 from 11 obsenatonal studies suggested no
association between COC use twas assumes
that tudes that dd not specify eral
contacapive ype examined most, nat
‘exclusively, COC use) and HI acquisition. No
‘Studies of the patch ring were denied 25
bi RIV infected
1 GD4 cout 2200 ces? 1 Evidence: Seven sides suggest no association
icone ana i between use of COC and progression of HIV. as
measured by CD4 count <200 elm’, nation
‘TART os mortality" One randomised
controlled rial fags an nereaced ik of
comporte outcome of decining CDA count or
‘death among COC users when compared with
AE
The major ofinrect studies measuring
whether various hormonal cortracepton med.
ect plasma HIV viral load Ind no elec
©) Taking arreter ARV) drugs | Geran ARV drugs have th potent o act ne bioavalabiiy of
der hormenes in hermonal eanraceptin.
For u- date information onthe potential drug interactions between
hormonal cetracepion and ARV drugs, please refer tothe onine HIV
rugs interaction checker"
2 E
DIAM orson cans ters on st aora aio tac pov sce
Steet minors ely ind ao ser sepa meas a ala ok
seach ener ‘neyo pepe hears an comi set condoms
‘Steed clr stew snot concep rsd ie onde
Conti or concept (COC) roca er TN
ori ta sa ra pach
vagina
“se stare tentation | néon Ms estan avs COC un. Ht,
Cannon | Mél ase pic decora
panna
‘Evidence: Lowto-moderate-qualty evidence
a Fah i LV econ 7 from 11 obsenatonal studies suggested no
association between COC use twas assumes
that tudes that dd not specify eral
contacapive ype examined most, nat
‘exclusively, COC use) and HI acquisition. No
‘Studies of the patch ring were denied 25
bi RIV infected
1 GD4 cout 2200 ces? 1 Evidence: Seven sides suggest no association
icone ana i between use of COC and progression of HIV. as
measured by CD4 count <200 elm’, nation
‘TART os mortality" One randomised
controlled rial fags an nereaced ik of
comporte outcome of decining CDA count or
‘death among COC users when compared with
AE
The major ofinrect studies measuring
whether various hormonal cortracepton med.
ect plasma HIV viral load Ind no elec
©) Taking arreter ARV) drugs | Geran ARV drugs have th potent o act ne bioavalabiiy of
der hormenes in hermonal eanraceptin.
For u- date information onthe potential drug interactions between
hormonal cetracepion and ARV drugs, please refer tothe onine HIV
rugs interaction checker"
2 E
DIAM orson cans ters on st aora aio tac pov sce
Steet minors ely ind ao ser sepa meas a ala ok
NesRHE EE.
Cortina Hormona Canracptan CC]. CHE donot pole aginst STN are a a STH ung ng
cats pregnancy pou he Comecnd coat sot onda
ed caer sons ow anne conrscepaon nod Nae condo
corn on Con PARCS EST
Sa gra
OTHER INFECTIONS
Tuberculosis
2) Non-pebe 1
b) Pete
Diabetes"
a) History ol gestational disease: 7 Evidence: The development oineninsum
‘dependent diabetes ln women wi a try of
eztatonldlabetes isnot incensed by the use
COC 5" Lkeuse, Ii lavas appear tobe
Unafected by COC use. "=:
D) Non vascular disease Evidence Among women with ins or non
insu dependent diabetes, COC use has ited
(i Norrinsuin dependent 2 sffecton daly insulin requirements and no efe
Te 2 ‘on ongtam dabetescontal (e.g HATO levels)
{progression 1 retinopathy. Changes nid
Profle and haemostatic markers ae ited and
Most changes remain wähn normal values."
ctra 5 eto, mecasgey sib aed
esc ERNEST
@ Ober vse dase 2
[>]
2 Sepia 1
D Fer 1
Een 1
Tandon be ators UI DA OS Wa A DO RTH HOOT
MMI nn most meu piper más Teno enc cotas por, nce
ÉTAT AE EEE wala a
Cortina Hormona Canracptan CC]. CHE donot pole aginst STN are a a STH ung ng
cats pregnancy pou he Comecnd coat sot onda
ed caer sons ow anne conrscepaon nod Nae condo
corn on Con PARCS EST
Sa gra
OTHER INFECTIONS
Tuberculosis
2) Non-pebe 1
b) Pete
Diabetes"
a) History ol gestational disease: 7 Evidence: The development oineninsum
‘dependent diabetes ln women wi a try of
eztatonldlabetes isnot incensed by the use
COC 5" Lkeuse, Ii lavas appear tobe
Unafected by COC use. "=:
D) Non vascular disease Evidence Among women with ins or non
insu dependent diabetes, COC use has ited
(i Norrinsuin dependent 2 sffecton daly insulin requirements and no efe
Te 2 ‘on ongtam dabetescontal (e.g HATO levels)
{progression 1 retinopathy. Changes nid
Profle and haemostatic markers ae ited and
Most changes remain wähn normal values."
ctra 5 eto, mecasgey sib aed
esc ERNEST
@ Ober vse dase 2
[>]
2 Sepia 1
D Fer 1
Een 1
Tandon be ators UI DA OS Wa A DO RTH HOOT
MMI nn most meu piper más Teno enc cotas por, nce
ÉTAT AE EEE wala a
‘ContinedHomonalcontacepton|CHC) CHE donot protect agas STO ar aot STV cng dng
seach ete egraney rpenpahmg comes an enter ao condo à
forte ater sn rats Corral ud condor
Cort or concept [COC] reta er TN
ori ta sa ra pach
vagina
“Sevsstuateonmertratendcteeton | néon Ms atan arto coe en. Het,
coman | halo ate pedi no coran
CTA
(GASTROINTESTINAL CONDITIONS
2) Symptomatic
(Treated by cholecystectomy 2
Ti Medical tested 3
3
2
3) Acute care ‘laification: Acto or fare: is category should
be assessed on the severtyofthecondton
D) Gamer 1 Evidence: Data suggest hatin women wih
chronic hepaitis, COC use does ot increase the
©) Gene 1 Fate or seventy of cinhoti ferris, nor does
increase the isk of hepatocelular carinama
Fer women who ar carers, COC use does
na appear o tigger liver falure or severe
Systincton + Evidences Emited for COC use
‘ring active nep
CR cr en
mass development of major complications
2) Mid (compensated without 1 (Gen as actes jaundice, encephalopathy or
complications) gastoesnalhaemomnage)
b) Severe (decompensated) 2
2 E
DIAM orson cans ters on st aora aio tac pov sce
Seine mens a soe ma nite neon wen nace ut
seach ete egraney rpenpahmg comes an enter ao condo à
forte ater sn rats Corral ud condor
Cort or concept [COC] reta er TN
ori ta sa ra pach
vagina
“Sevsstuateonmertratendcteeton | néon Ms atan arto coe en. Het,
coman | halo ate pedi no coran
CTA
(GASTROINTESTINAL CONDITIONS
2) Symptomatic
(Treated by cholecystectomy 2
Ti Medical tested 3
3
2
3) Acute care ‘laification: Acto or fare: is category should
be assessed on the severtyofthecondton
D) Gamer 1 Evidence: Data suggest hatin women wih
chronic hepaitis, COC use does ot increase the
©) Gene 1 Fate or seventy of cinhoti ferris, nor does
increase the isk of hepatocelular carinama
Fer women who ar carers, COC use does
na appear o tigger liver falure or severe
Systincton + Evidences Emited for COC use
‘ring active nep
CR cr en
mass development of major complications
2) Mid (compensated without 1 (Gen as actes jaundice, encephalopathy or
complications) gastoesnalhaemomnage)
b) Severe (decompensated) 2
2 E
DIAM orson cans ters on st aora aio tac pov sce
Seine mens a soe ma nite neon wen nace ut
Ne
FSRH Rda.
Conti Homena Cantacepion GH]. CHE donot proc agunt STINT we rte STH cg tg
ee, See
en EEE EEE
Eee
mae
oe lr
ea
a a,
Ter lesions among women win focal nodular
hyperplasia There sno evidence rating
(O Focal ar hyperplasia 2 {ose of hormonal conracepton by waren wth
(© Hepatocelular adenoma 7 tir ver tumeurs.
D) Malignant hapaorelular cranama) 4
Inflammatory bowel disease (BD)* 2
Erie Clarification: Continuation may needtobe
Feviewed the woman has an acute exacerbation,
Aie surgery er preenged immobilaten (see
Seaton on VIE),
Evidence: Risk fr disease relapse i not
“ignficanty higher among women with 18D using
‘al contracepion most shudes donot sect
‘wees ts POP or OG) than among nen
‘Absorption of COC among women with mild
eersiv cat and no or smal eal resections
IS mir tothe absorption among heathy
Women 3 Findings may net apply o women
‘wah Crone Ansase or more extensive Bowel
resections
No data exist hat evaluate the increases ik
{er VTE among wemen wth IBD using CHC.
However women wih 18D ae a higher than
Unatectea women for VTE
‘anon be ECOS UI De MS Y RAR DO STATS AORTA
A eta
FSRH Rda.
Conti Homena Cantacepion GH]. CHE donot proc agunt STINT we rte STH cg tg
ee, See
en EEE EEE
Eee
mae
oe lr
ea
a a,
Ter lesions among women win focal nodular
hyperplasia There sno evidence rating
(O Focal ar hyperplasia 2 {ose of hormonal conracepton by waren wth
(© Hepatocelular adenoma 7 tir ver tumeurs.
D) Malignant hapaorelular cranama) 4
Inflammatory bowel disease (BD)* 2
Erie Clarification: Continuation may needtobe
Feviewed the woman has an acute exacerbation,
Aie surgery er preenged immobilaten (see
Seaton on VIE),
Evidence: Risk fr disease relapse i not
“ignficanty higher among women with 18D using
‘al contracepion most shudes donot sect
‘wees ts POP or OG) than among nen
‘Absorption of COC among women with mild
eersiv cat and no or smal eal resections
IS mir tothe absorption among heathy
Women 3 Findings may net apply o women
‘wah Crone Ansase or more extensive Bowel
resections
No data exist hat evaluate the increases ik
{er VTE among wemen wth IBD using CHC.
However women wih 18D ae a higher than
Unatectea women for VTE
‘anon be ECOS UI De MS Y RAR DO STATS AORTA
A eta
‘ContinedHomonalcontacepton|CHC) CHE donot protect agas STO ar aot STV cng dng
seach ener nme) pen Seca conte etc
ersten eier cape mates condos
Cort or concept [COC] reta er TN
ori ta sa ra pach
vagina
“Sevsstuateonmertratendcteeton | néon Ms atan arto coe en. Het,
coman | halo ate pedi no coran
CTA
ANAEMAS
Sicko cell disease
Iron deficoncy anaemia
RHEUMATIC DISEASES
Rhaumatoid artritis 2 Clarification: Risk of CVDis incensed among
‘women with memos ath
Evidence: Limited exdence shows no
consisten pattem of improvement or worsening
Sf meumatad arts wih use of eral
ceonaception 0
ie lupus erythematosus ‘laifiction: People with SLE are aan
increased sk of ischaemi ea disease, are
and VIE aná this reflected in the categories
2) No antiphospholipid antibodies 2 TE ee darle ados vor
D) Postive antiphospholipid + Causes disease far,
antibodies
valable evidence ndeates that many women
vith SLE can be considered good canadates
for most methods of contacepton, cluding
hmenalcotracepton "="
cocos ca
DIAM orson cans ters on st aora aio tac pov sce
Steet minors ely ind ao ser sepa meas a ala ok
seach ener nme) pen Seca conte etc
ersten eier cape mates condos
Cort or concept [COC] reta er TN
ori ta sa ra pach
vagina
“Sevsstuateonmertratendcteeton | néon Ms atan arto coe en. Het,
coman | halo ate pedi no coran
CTA
ANAEMAS
Sicko cell disease
Iron deficoncy anaemia
RHEUMATIC DISEASES
Rhaumatoid artritis 2 Clarification: Risk of CVDis incensed among
‘women with memos ath
Evidence: Limited exdence shows no
consisten pattem of improvement or worsening
Sf meumatad arts wih use of eral
ceonaception 0
ie lupus erythematosus ‘laifiction: People with SLE are aan
increased sk of ischaemi ea disease, are
and VIE aná this reflected in the categories
2) No antiphospholipid antibodies 2 TE ee darle ados vor
D) Postive antiphospholipid + Causes disease far,
antibodies
valable evidence ndeates that many women
vith SLE can be considered good canadates
for most methods of contacepton, cluding
hmenalcotracepton "="
cocos ca
DIAM orson cans ters on st aora aio tac pov sce
Steet minors ely ind ao ser sepa meas a ala ok
NesRHE EE.
Cortina Hormona Canracptan CC]. CHE donot pole aginst STN are a a STH ung ng
cats rene post he cect ad consiste no cord
ed caer sons ow anne conrscepaon nod Nae condo
corn on Con PARCS EST
Sa gra
4 Ciaficaton: Postveaniphosphalipid antbodies
(AP) is atisea disease state aná in the
absence of maniestatons fhe aniphospholpid
Syndrome a satiation of risk wth specialist
advice necessary I recommended. In particular,
persistence of aPL post. high te of PL.
lupus anicoaguant (LA) post. tiple post
for anicareicein anibodes (CL), anh 62
jycepreten 1 (BP) and LA and immunopebuin
196) aPL have greater isk for eure
a
‘See section an drug nterachons with homonal contraception
Positive antiphospholipid
antibodies
Taking medicion
Tandon be CIO UI DA OS Y A DO DENT
o A a
A A AS
Cortina Hormona Canracptan CC]. CHE donot pole aginst STN are a a STH ung ng
cats rene post he cect ad consiste no cord
ed caer sons ow anne conrscepaon nod Nae condo
corn on Con PARCS EST
Sa gra
4 Ciaficaton: Postveaniphosphalipid antbodies
(AP) is atisea disease state aná in the
absence of maniestatons fhe aniphospholpid
Syndrome a satiation of risk wth specialist
advice necessary I recommended. In particular,
persistence of aPL post. high te of PL.
lupus anicoaguant (LA) post. tiple post
for anicareicein anibodes (CL), anh 62
jycepreten 1 (BP) and LA and immunopebuin
196) aPL have greater isk for eure
a
‘See section an drug nterachons with homonal contraception
Positive antiphospholipid
antibodies
Taking medicion
Tandon be CIO UI DA OS Y A DO DENT
o A a
A A AS
Additional Comments
HYPERTENSION, CURRENT AND HISTORY OF ISCHAEMIC HEART DISEASE, STROKE
À Single reading of BP level is not sufcent to classify a woman as hypertensive. elevated, the BP
Shoud be reassessed atthe end of te consultation. BP is increased, it should be reassessed and
monitored according to current guidelines,
‘SUPERFICIAL VENOUS THROMBOSIS
Varicose vain: Varicose veins are nota ik factor fr VTE.
VALVULAR AND CONGENITAL HEART DISEASE, CARDIOMYOPATHY AND CARDIAC
ARRHYTHMIAS
Stasis, endothelial injury and hyperviscosiy (Virchows tiad) increase the risk of clot formation. Impaired
Cardiac function andlor dated heart chambers or ahythmia increase the ik of stasis. Closure of
cardiac defect within the last 6 months or presence of a mechanical heart valve increases the isk
‘of thrombus formation. Cyanate defects are associated wih hypendscosity because of increased
enirocytoss
Congenital hart disease: Surgical correction. co-existing complications and degree of cardiac
sabi wil vary between individuals and shouldbe taken into accaunt when considenng contraception
UNEXPLANED VAGINAL BLEEDING
‘There are no conditions that cause vaginal bleeding that willbe worsened in the short term by use of
cmo.
ENDOMETRIOSIS
CHC do not worsen, and may alleviate, Ihe symptoms of endometriosis
CERVICAL ECTROPION
Cervical ecropion I not risk factor for cervical cancer and there is no need or restriction of CHC.
CERVICAL CANCER
‘Awaiting treatment: There is some theoretcal concern that CHC use may affect prognosis ofthe
‘exiting disease. While awaling treatment, women may use CHC since the period of wating i key to
be brief and pregnancy would be contraindicated.
ENDOMETRIAL AND OVARIAN CANCER
(COC use reduces the risk of developing endometrial cancer. While awaitng treatment, women may use
oc,
UTERINE FIBROIDS
‘There ls no evidence that CHC affect growth of raids,
HIVINFECTION
Women with HIV infection often have co-motidties that may influence their choice of contraception.
DIABETES
Although carbohydrate tolerance may change with CHC use, te major concerns are vascular disease
ue to diabetes and adatonal isk of arterial trombosis due to use of CHC.
GALLBLADDER DISEASE
COC may cause a small increased risk of gallbladder disease. There is also concem that COC may
‘worsen existing gallbladder disease.
HISTORY OF CHOLESTASIS
Pregnancy related: History of pregnancy-related cholestasis may predict an increased risk of
developing COC-assocated cholestasis.
HYPERTENSION, CURRENT AND HISTORY OF ISCHAEMIC HEART DISEASE, STROKE
À Single reading of BP level is not sufcent to classify a woman as hypertensive. elevated, the BP
Shoud be reassessed atthe end of te consultation. BP is increased, it should be reassessed and
monitored according to current guidelines,
‘SUPERFICIAL VENOUS THROMBOSIS
Varicose vain: Varicose veins are nota ik factor fr VTE.
VALVULAR AND CONGENITAL HEART DISEASE, CARDIOMYOPATHY AND CARDIAC
ARRHYTHMIAS
Stasis, endothelial injury and hyperviscosiy (Virchows tiad) increase the risk of clot formation. Impaired
Cardiac function andlor dated heart chambers or ahythmia increase the ik of stasis. Closure of
cardiac defect within the last 6 months or presence of a mechanical heart valve increases the isk
‘of thrombus formation. Cyanate defects are associated wih hypendscosity because of increased
enirocytoss
Congenital hart disease: Surgical correction. co-existing complications and degree of cardiac
sabi wil vary between individuals and shouldbe taken into accaunt when considenng contraception
UNEXPLANED VAGINAL BLEEDING
‘There are no conditions that cause vaginal bleeding that willbe worsened in the short term by use of
cmo.
ENDOMETRIOSIS
CHC do not worsen, and may alleviate, Ihe symptoms of endometriosis
CERVICAL ECTROPION
Cervical ecropion I not risk factor for cervical cancer and there is no need or restriction of CHC.
CERVICAL CANCER
‘Awaiting treatment: There is some theoretcal concern that CHC use may affect prognosis ofthe
‘exiting disease. While awaling treatment, women may use CHC since the period of wating i key to
be brief and pregnancy would be contraindicated.
ENDOMETRIAL AND OVARIAN CANCER
(COC use reduces the risk of developing endometrial cancer. While awaitng treatment, women may use
oc,
UTERINE FIBROIDS
‘There ls no evidence that CHC affect growth of raids,
HIVINFECTION
Women with HIV infection often have co-motidties that may influence their choice of contraception.
DIABETES
Although carbohydrate tolerance may change with CHC use, te major concerns are vascular disease
ue to diabetes and adatonal isk of arterial trombosis due to use of CHC.
GALLBLADDER DISEASE
COC may cause a small increased risk of gallbladder disease. There is also concem that COC may
‘worsen existing gallbladder disease.
HISTORY OF CHOLESTASIS
Pregnancy related: History of pregnancy-related cholestasis may predict an increased risk of
developing COC-assocated cholestasis.
TER
Past COC-related: History of COC related cholestasis predicts an increased risk with subsequent COC
VIRAL HEPATITIS, CIRRHOSIS AND LIVER TUMOURS
(COC are metabolised bythe liver, and ther use may adversely affect women whose liver function is
compromised.
INFLAMMATORY BOWEL DISEASE (8D)
Risk of VTE may increase if unwell, bed-Dound or undergoing acute surgery or with major surgery and
prolonged immebilsation. Under trese circumstances the use of combined methods should be aveided
{and allematve methods used
THALASSAEMIA
There is anecdotal evidence from counties where thalassaemia is prevalent hat COC use does not
worsen the eonaton.
IRON-DEFICIENCY ANAEMIA
(CHC use may decrease menstual blood oss.
DRUG INTERACTIONS
General. the safety ofusing combined hormonal methods is unaffected. Nevertheless, use of
liver enzyme inducing medication may reduce contraception efficacy, increasing risk of unintended
pregnancy Contraception cholos may depend on Me likely duration of use of concurrent medications
and need for addtional or alemaive methods,
Past COC-related: History of COC related cholestasis predicts an increased risk with subsequent COC
VIRAL HEPATITIS, CIRRHOSIS AND LIVER TUMOURS
(COC are metabolised bythe liver, and ther use may adversely affect women whose liver function is
compromised.
INFLAMMATORY BOWEL DISEASE (8D)
Risk of VTE may increase if unwell, bed-Dound or undergoing acute surgery or with major surgery and
prolonged immebilsation. Under trese circumstances the use of combined methods should be aveided
{and allematve methods used
THALASSAEMIA
There is anecdotal evidence from counties where thalassaemia is prevalent hat COC use does not
worsen the eonaton.
IRON-DEFICIENCY ANAEMIA
(CHC use may decrease menstual blood oss.
DRUG INTERACTIONS
General. the safety ofusing combined hormonal methods is unaffected. Nevertheless, use of
liver enzyme inducing medication may reduce contraception efficacy, increasing risk of unintended
pregnancy Contraception cholos may depend on Me likely duration of use of concurrent medications
and need for addtional or alemaive methods,
Emergency Contraception (EC)
Emergency contraception (EC) provides women cf al reproducive ages with a means of preventing
Unintended pregnancy folowing any unprotected sexual intercourse (UPSI).
‘The section on emergency contraception includes te following types:
+ Copper-bearng IUD (CusUD)
+ Oral emergency contraception (EC)
FSRH guidance on EC! and UC: is avaiable on the FSRH website,
opps 1g UD (CusUD) for emergency contraception
‘The CuAUD is the most effecive form of EC. Al eligible women presenting between 9 and 120 hours of
LUPSI or within 5 days of expected ovulation (Day 19 in a regular 28-day cycle) should be offered a Cu-IUD
because ofthe ow documented flue ate
‘The eigilty criteria for interval CuIUD insertion also apply fr the insertion ofthe CuJUD as EC.
However. the rstcbenefi rato wil be diferent fr the use of the CUAUD as EC compared to when itisused
for routine contraception.
Oral emergency contraception
Two meihods of oral EC are avalable in the UK.
ipristl acetate (UPA) sa progesterone receptor modulator thats a synthetic steroid derived from
19nomrogesterone and is Icensed for use within 120 hours of UPSI
Oral progestogen-only EC containing LNG 1.5 mg is licensed to be given up to 72 hours after UPSI or
contraceptive fallre. There is some evidence of reduced efficacy with use ater 72 hours >
Emergency contraception (EC) provides women cf al reproducive ages with a means of preventing
Unintended pregnancy folowing any unprotected sexual intercourse (UPSI).
‘The section on emergency contraception includes te following types:
+ Copper-bearng IUD (CusUD)
+ Oral emergency contraception (EC)
FSRH guidance on EC! and UC: is avaiable on the FSRH website,
opps 1g UD (CusUD) for emergency contraception
‘The CuAUD is the most effecive form of EC. Al eligible women presenting between 9 and 120 hours of
LUPSI or within 5 days of expected ovulation (Day 19 in a regular 28-day cycle) should be offered a Cu-IUD
because ofthe ow documented flue ate
‘The eigilty criteria for interval CuIUD insertion also apply fr the insertion ofthe CuJUD as EC.
However. the rstcbenefi rato wil be diferent fr the use of the CUAUD as EC compared to when itisused
for routine contraception.
Oral emergency contraception
Two meihods of oral EC are avalable in the UK.
ipristl acetate (UPA) sa progesterone receptor modulator thats a synthetic steroid derived from
19nomrogesterone and is Icensed for use within 120 hours of UPSI
Oral progestogen-only EC containing LNG 1.5 mg is licensed to be given up to 72 hours after UPSI or
contraceptive fallre. There is some evidence of reduced efficacy with use ater 72 hours >
‘CONDITION. CATEGORY
sa carmen ands Kaya um [US CLARIFICATIONEMDENCE
» ma | NA | NA | Clarification: There ienoknown harm othe
‘woman, the course of her pregnancy othe
fetus UPA LNG is seccertaty es,
CuIUD can be inserte upto 5 days ater the
fst episode of UPS e necessary up lo 5
days arte expected dae of ova (Day
19% a regular 28 day eye)
= s Ctarflcaion: EC is not required UPS
E a (Dario method flure ceca <3 weeks
pospartum. UPA and LNG are indicated fom
DE NA | NA | NA | Sweeks postpatum, Emergency CUIUD la
DECEO 3 13 [3 | ndeste tom 4 weeks postparum.
zm 3.19] + | ctartteation: Bresatesdngis not
recommended fr Y week er taking UPA
‘ince tis excreted in breast ik, Great me
Should be expressed and discarded during that
me:
Past ectopic pregnancy 3 [1 | 1 | elarifieation: Women using ontaception
have a lower risk of ecepie pregnancy overall
compared to women not using contraception,
‘here does nt appear tobe an increased sk
of etoiepregnaney flowing use of CUD
28 EC; UPA’ er ING?
2 E
— A EE ear
sa carmen ands Kaya um [US CLARIFICATIONEMDENCE
» ma | NA | NA | Clarification: There ienoknown harm othe
‘woman, the course of her pregnancy othe
fetus UPA LNG is seccertaty es,
CuIUD can be inserte upto 5 days ater the
fst episode of UPS e necessary up lo 5
days arte expected dae of ova (Day
19% a regular 28 day eye)
= s Ctarflcaion: EC is not required UPS
E a (Dario method flure ceca <3 weeks
pospartum. UPA and LNG are indicated fom
DE NA | NA | NA | Sweeks postpatum, Emergency CUIUD la
DECEO 3 13 [3 | ndeste tom 4 weeks postparum.
zm 3.19] + | ctartteation: Bresatesdngis not
recommended fr Y week er taking UPA
‘ince tis excreted in breast ik, Great me
Should be expressed and discarded during that
me:
Past ectopic pregnancy 3 [1 | 1 | elarifieation: Women using ontaception
have a lower risk of ecepie pregnancy overall
compared to women not using contraception,
‘here does nt appear tobe an increased sk
of etoiepregnaney flowing use of CUD
28 EC; UPA’ er ING?
2 E
— A EE ear
‘CONDITION CATEGORY
‘Senin coment tend oo um INS CCLARIFICATIONEVIDENCE
3 ] 1 | 1 | Evidence: A revew by the European
Medicines Agency determines tat data
valable ae too Imted and nok robust
‘enought conclude sh any catty
that cortracepive eect is reduced wth
increased body weight. The Agency s
Commitee fr Medeinal Products for Human
Use recemmends hat LING and UPA coa
continue 1 be used in women of all weights
‘asthe benett ar considered lo outweigh he
>
Hypertension co
Known dyslipidoon co 7
Venous thromboembolism 2 | 2 | 2 | Clacaton: VTE nauses OVT and PE
rer
{Curren VTE (on aniesaguiant
History of severe CVD 1 [1 | 1 | elartcaion: There eno evidence that UPA
complications SUNG increase the ik of CVD,
Headaches + | 1 | 1 | etatcaion: Headache isa common
condition afecing women of reproductive age.
Gestational trophoblastic
sense (GTO)
2) Undetedable CG leves 1 [1 [1 | ctaritcaion: includes ryaattemn male
DT 3 | + | | tcomplete and parta) and gestational
trophoblastic neopiasa.
©) Persistenty elevated HCG a+
leves or malignant dsease
cocos ca
RE snr tera sans rege pov, ance
Steet minors ely ind ao ser sepa meas a ala ok
‘Senin coment tend oo um INS CCLARIFICATIONEVIDENCE
3 ] 1 | 1 | Evidence: A revew by the European
Medicines Agency determines tat data
valable ae too Imted and nok robust
‘enought conclude sh any catty
that cortracepive eect is reduced wth
increased body weight. The Agency s
Commitee fr Medeinal Products for Human
Use recemmends hat LING and UPA coa
continue 1 be used in women of all weights
‘asthe benett ar considered lo outweigh he
>
Hypertension co
Known dyslipidoon co 7
Venous thromboembolism 2 | 2 | 2 | Clacaton: VTE nauses OVT and PE
rer
{Curren VTE (on aniesaguiant
History of severe CVD 1 [1 | 1 | elartcaion: There eno evidence that UPA
complications SUNG increase the ik of CVD,
Headaches + | 1 | 1 | etatcaion: Headache isa common
condition afecing women of reproductive age.
Gestational trophoblastic
sense (GTO)
2) Undetedable CG leves 1 [1 [1 | ctaritcaion: includes ryaattemn male
DT 3 | + | | tcomplete and parta) and gestational
trophoblastic neopiasa.
©) Persistenty elevated HCG a+
leves or malignant dsease
cocos ca
RE snr tera sans rege pov, ance
Steet minors ely ind ao ser sepa meas a ala ok
‘CONDITION. CATEGORY
sa carmen ands Kaya um [US CLARIFICATIONEMDENCE
Breast cancer Ctarfication: Anough the prognesis of
‘women wih breas cancer may be affected
2) Curent breast cancer 41 | 2 | 2 J oyhormeonal methods of contraception. ne
D) Past breast cancer + [2 | 2 rene acond
sts
a) Without ditorion ftheuteine | 1 | 1 | 1
avy
D) With tortion ofthe >|]
Uterine cay
2) Distorted uterine cavity 3 [+ | 1 | ctaricaton: neues any congental or
acquired uterino abnermaly itring the
Uterine cavty in a manner at isincompatible
"sen UC insertion
D) Other abnorm 2 | 3 | 1 | ctaritestion: neudes ceviea stenosis or
‘cereal lacerations nal dating the uterine
Say oriterfering with IUC insertion,
Inflammatory bowel disease 7 12 | 2 | cteriteaton: Oral methods may be less
ineuding Crohns disease and relabe here is signifeant malabsepton or
Ulcerative cas) mal bowel resection (paricuary wth Crohn's
disease) Oral methods are unaected by
csectomy and ostomy.
Sever ver disease" ılıfı
or: POE
CU RE EE ear
sa carmen ands Kaya um [US CLARIFICATIONEMDENCE
Breast cancer Ctarfication: Anough the prognesis of
‘women wih breas cancer may be affected
2) Curent breast cancer 41 | 2 | 2 J oyhormeonal methods of contraception. ne
D) Past breast cancer + [2 | 2 rene acond
sts
a) Without ditorion ftheuteine | 1 | 1 | 1
avy
D) With tortion ofthe >|]
Uterine cay
2) Distorted uterine cavity 3 [+ | 1 | ctaricaton: neues any congental or
acquired uterino abnermaly itring the
Uterine cavty in a manner at isincompatible
"sen UC insertion
D) Other abnorm 2 | 3 | 1 | ctaritestion: neudes ceviea stenosis or
‘cereal lacerations nal dating the uterine
Say oriterfering with IUC insertion,
Inflammatory bowel disease 7 12 | 2 | cteriteaton: Oral methods may be less
ineuding Crohns disease and relabe here is signifeant malabsepton or
Ulcerative cas) mal bowel resection (paricuary wth Crohn's
disease) Oral methods are unaected by
csectomy and ostomy.
Sever ver disease" ılıfı
or: POE
CU RE EE ear
‘CONDITION (CATEGORY
ue | um | INS
“See ln contents sod of CCLARIFICATIONEVIDENCE
‘econ
+] 2 | 2 [eue Acts ciomitnt porn ia
tea uc ud ld
Pen ies ero alerte
fatal Inne popular stay it al of
er vapor) us oran concepton
Een) ti Maman ane at
Cane ormonalcontecertin le hon
torn dl ee einen N
tobe aesogated wi acto dans mare cea han
“repens hormones
omen ay usa UPA ot LNG King session
men
WA | 1 | 1 | stare: Rocamora of mannan
bat te woman equtes hehe cussion about
‘he consacetve pone UPA a ING can
ied mee Pan cena ya incl
‘dated Arava, 2 UD can be neared
aptes USS eects upto aay oer the fat
tito pos sar pto aye aer
AS
Frequent pated UPA ná ING use may be
(toga 2 dl OC er BOC we
+ | 1 | 1 | elartestion: Women though t beat higher
Fisk of TI fom thar sexual Nistor (aged <25
years, or wih a change in sexual partner or
voor more partners nthe lat year shod
be ofered tesing for STI
Ina woman wah asymptomatic clamysa
in an emergency station Le. emergency
contracepton) the CUsUD cod be inserted
‘onthe same day as treatments nsttuted.
‘See section on du interactions with hormonal centracepton.
NOIA an DIE ven ROG una IA me TAT ONT
DE maps aus mol cnc una snr tea sap em pov, ance
Seige neers an soe ma events need wee pol
ue | um | INS
“See ln contents sod of CCLARIFICATIONEVIDENCE
‘econ
+] 2 | 2 [eue Acts ciomitnt porn ia
tea uc ud ld
Pen ies ero alerte
fatal Inne popular stay it al of
er vapor) us oran concepton
Een) ti Maman ane at
Cane ormonalcontecertin le hon
torn dl ee einen N
tobe aesogated wi acto dans mare cea han
“repens hormones
omen ay usa UPA ot LNG King session
men
WA | 1 | 1 | stare: Rocamora of mannan
bat te woman equtes hehe cussion about
‘he consacetve pone UPA a ING can
ied mee Pan cena ya incl
‘dated Arava, 2 UD can be neared
aptes USS eects upto aay oer the fat
tito pos sar pto aye aer
AS
Frequent pated UPA ná ING use may be
(toga 2 dl OC er BOC we
+ | 1 | 1 | elartestion: Women though t beat higher
Fisk of TI fom thar sexual Nistor (aged <25
years, or wih a change in sexual partner or
voor more partners nthe lat year shod
be ofered tesing for STI
Ina woman wah asymptomatic clamysa
in an emergency station Le. emergency
contracepton) the CUsUD cod be inserted
‘onthe same day as treatments nsttuted.
‘See section on du interactions with hormonal centracepton.
NOIA an DIE ven ROG una IA me TAT ONT
DE maps aus mol cnc una snr tea sap em pov, ance
Seige neers an soe ma events need wee pol
TER
Additional Comments
POSTPARTUM.
Breastfeeding: Athough women who are fully or nearly fly breastfeeding, amenorrhoeic and
“<6 months postpartum can rely on LAM as an effective method of contraception ifbreastfeeding
frequency decreases or menstruation recurs EC may be indicated,
VENOUS THROMBOEMBOLISM
Current VTE taking anticoagulants: Care should be taken when fting a Cu-IUD in those taking
‘anticoagulants as there may be an increased risk of bleeding
UTERINE FIBROIDS AND ANATOMICAL ABNORMALITIES (distorted uterine cavity)
In women wit a distorted uterine cavity it may be appropriate after discussion o attempt insertion of
CULO.
‘SEVERE LIVER DISEASE
‘The duration of use of UPA or LNG isless than that of regular use of POP and tus would be expected
to have less clinical impact
ACUTE INTERMITTENT PORPHYRIA
úOycical symptoms have been found in elation tothe menstrual cycle but seldom lead to acute attacks.
RISK OF SEXUALLY TRANSMITTED INFECTIONS (STIs)
Women who are thought tobe at higher risk for STI based on a sexual history (age <25 years or age
>25 years witha change in sexual partner or two of more partners inthe last year) can be offered
testing fr STIs and should be given prophylactic anibietes to prevent Chiamydia trachomatis at the
time of CUAUD insertion,
DRUG INTERACTIONS
(Current FSRH guidance recommends that women using Iver enzyme inducers should be advised
House a Cu-IUD. If rogestogen-only EC is to be used it should be given as soon as possible and
within 72 hours of UPI. In women using Iver enzyme inducing drugs, two 1.5 mg LNG tablets should
be taken (3 mg) asa single dose, The efficacy of LNG isnot reduced by non-iver enzyme inducing
antbiotes,
Additional Comments
POSTPARTUM.
Breastfeeding: Athough women who are fully or nearly fly breastfeeding, amenorrhoeic and
“<6 months postpartum can rely on LAM as an effective method of contraception ifbreastfeeding
frequency decreases or menstruation recurs EC may be indicated,
VENOUS THROMBOEMBOLISM
Current VTE taking anticoagulants: Care should be taken when fting a Cu-IUD in those taking
‘anticoagulants as there may be an increased risk of bleeding
UTERINE FIBROIDS AND ANATOMICAL ABNORMALITIES (distorted uterine cavity)
In women wit a distorted uterine cavity it may be appropriate after discussion o attempt insertion of
CULO.
‘SEVERE LIVER DISEASE
‘The duration of use of UPA or LNG isless than that of regular use of POP and tus would be expected
to have less clinical impact
ACUTE INTERMITTENT PORPHYRIA
úOycical symptoms have been found in elation tothe menstrual cycle but seldom lead to acute attacks.
RISK OF SEXUALLY TRANSMITTED INFECTIONS (STIs)
Women who are thought tobe at higher risk for STI based on a sexual history (age <25 years or age
>25 years witha change in sexual partner or two of more partners inthe last year) can be offered
testing fr STIs and should be given prophylactic anibietes to prevent Chiamydia trachomatis at the
time of CUAUD insertion,
DRUG INTERACTIONS
(Current FSRH guidance recommends that women using Iver enzyme inducers should be advised
House a Cu-IUD. If rogestogen-only EC is to be used it should be given as soon as possible and
within 72 hours of UPI. In women using Iver enzyme inducing drugs, two 1.5 mg LNG tablets should
be taken (3 mg) asa single dose, The efficacy of LNG isnot reduced by non-iver enzyme inducing
antbiotes,
UKMEC SUMMARY TABLE HORMONAL
AND INTRAUTERINE CONTRACEPTION
Progestogeronl implant DMPA = Progestoge-ory injectable depot medronyprogesterone acetato
POP = Progestogerer embed hormonal contraception
‘CONDITION CuUD LNGIUS IMP POP CHO
Pregnancy
age
Party
2) Oto <8 weeks postpartum
) 25 weeks to <6 mons
{primasly beasteeding)
©) 26 months postparum
Postpartum (n nonbreadteedng women)
2) Oto <3 weeks
(With ether ak actor or VTE ï 7
Without aer risk factors 1 +
DES
D ner actor or TE. 1 2 7
CU) out ether risk factors 1 4 1
©) BB weeks 1 1 1 1
“conan mer he ares ot angie say ua ne aT OT
EER) 2302104000020 = prove ras cay omaha onannpm dang rapes moon
ens pape rae de ean conga pen ies
"ACO D ms u
AND INTRAUTERINE CONTRACEPTION
Progestogeronl implant DMPA = Progestoge-ory injectable depot medronyprogesterone acetato
POP = Progestogerer embed hormonal contraception
‘CONDITION CuUD LNGIUS IMP POP CHO
Pregnancy
age
Party
2) Oto <8 weeks postpartum
) 25 weeks to <6 mons
{primasly beasteeding)
©) 26 months postparum
Postpartum (n nonbreadteedng women)
2) Oto <3 weeks
(With ether ak actor or VTE ï 7
Without aer risk factors 1 +
DES
D ner actor or TE. 1 2 7
CU) out ether risk factors 1 4 1
©) BB weeks 1 1 1 1
“conan mer he ares ot angie say ua ne aT OT
EER) 2302104000020 = prove ras cay omaha onannpm dang rapes moon
ens pape rae de ean conga pen ies
"ACO D ms u
ACTE
UKMEG SUMMARY TABLE HORMONAL AND INTRAUTERINE CONTRACEPTION
© on, © = Continuation
2) Docta CU E1
D) éteust canes of =
Er 4
6) Popa spas co
EE .
2) rra menes CO ICI CI CI CI ET
D) Sein mesa ES CI CI CS CI
) Pos sboren ps E CI CIS ICI CI
Pos ecto pregnancy CO CIO ICI CIS IC
History of pte surgery
Ill» dada
smoking
DE ED CIO CIS IC ICI Tr
D) non yrs
DE ED CIO CIS CIS CI ES
215 pretty ED CIS CIS CIS ICI E
09 Seped anne Ta CI ICI CI IE
(Seppe smoking 2 year EI CIS CI IC ICI E
DES ED ACI CI IC CI EZ
D) Bus ig ED CIS CI ICI CI E
con Raco
co? er EEE EEE]
SROs sees oar Hg
UKMEG SUMMARY TABLE HORMONAL AND INTRAUTERINE CONTRACEPTION
© on, © = Continuation
2) Docta CU E1
D) éteust canes of =
Er 4
6) Popa spas co
EE .
2) rra menes CO ICI CI CI CI ET
D) Sein mesa ES CI CI CS CI
) Pos sboren ps E CI CIS ICI CI
Pos ecto pregnancy CO CIO ICI CIS IC
History of pte surgery
Ill» dada
smoking
DE ED CIO CIS IC ICI Tr
D) non yrs
DE ED CIO CIS CIS CI ES
215 pretty ED CIS CIS CIS ICI E
09 Seped anne Ta CI ICI CI IE
(Seppe smoking 2 year EI CIS CI IC ICI E
DES ED ACI CI IC CI EZ
D) Bus ig ED CIS CI ICI CI E
con Raco
co? er EEE EEE]
SROs sees oar Hg
UKMEC SUMMARY TABLE HORMONAL AND INTRAUTERINE CONTRACEPTION
Coninumion
2) With BMI <20 gin? 1 1 1 1 1 1
D) Win BM 230-94 kg 1 1 1 1 1
ET 1 1 1 1 1
2) Compleated: ga fare (acute or
onic) rjecton cardiac alograt 2 2 2 3
vaseuepany
Dj Uncomplicated 2 2 2 2 2 2
‘CARDIOVASCULAR DISEASE (CVD)
Mutipl risk factors for CVD (such as
smoking, diabetes, hypertension. obesty | 1 2 2 3 2 3
and dyapisaemi
2) Adequatey contd hypertension 1 1 1 2 1 3
) Consistenty elevated BP levels
(Groperty taker measurements)
© Syste > 140-159 mmHg or
Santo >90-99 mmHg 1 1 ‘ u ‘ ®
© Syste 2180 mm or
dance 2100 mt E E 1 2 2 &
©) Vascular disease
History of high BP during pregnancy
Stroke (history cerebro
dent, including TIA)
Known dyslipidaemias
RGO NDS D mia gay OI DEAR OT HO
DRE 5e mec ee e Moro
nr aerate moss rsa wn ase
Coninumion
2) With BMI <20 gin? 1 1 1 1 1 1
D) Win BM 230-94 kg 1 1 1 1 1
ET 1 1 1 1 1
2) Compleated: ga fare (acute or
onic) rjecton cardiac alograt 2 2 2 3
vaseuepany
Dj Uncomplicated 2 2 2 2 2 2
‘CARDIOVASCULAR DISEASE (CVD)
Mutipl risk factors for CVD (such as
smoking, diabetes, hypertension. obesty | 1 2 2 3 2 3
and dyapisaemi
2) Adequatey contd hypertension 1 1 1 2 1 3
) Consistenty elevated BP levels
(Groperty taker measurements)
© Syste > 140-159 mmHg or
Santo >90-99 mmHg 1 1 ‘ u ‘ ®
© Syste 2180 mm or
dance 2100 mt E E 1 2 2 &
©) Vascular disease
History of high BP during pregnancy
Stroke (history cerebro
dent, including TIA)
Known dyslipidaemias
RGO NDS D mia gay OI DEAR OT HO
DRE 5e mec ee e Moro
nr aerate moss rsa wn ase
SR
UKMEC SUMMARY TABLE HORMONAL AND INTRAUTERINE CONTRACEPTION
E Initiation, € = Continuation
So as
OEA
AAA RE
IC CI CI ICI IC
ae
pa TA
aa | je
mean 1 RE D AE
ESS
Es RME CI IC
AA ER M CIO ACI ACI
a EE
soon? o
O eme cone 0 mesos ea amaprne aries ny Do mapas Meran
UKMEC SUMMARY TABLE HORMONAL AND INTRAUTERINE CONTRACEPTION
E Initiation, € = Continuation
So as
OEA
AAA RE
IC CI CI ICI IC
ae
pa TA
aa | je
mean 1 RE D AE
ESS
Es RME CI IC
AA ER M CIO ACI ACI
a EE
soon? o
O eme cone 0 mesos ea amaprne aries ny Do mapas Meran
UKMEG SUMMARY TABLE HORMONAL AND INTRAUTERINE CONTRACEPTION
tion © = Continuation
2) Uncomplicated 1 TA 1 1 2
b) Complicated (eg. pulmonary
hypertension, istry of subacute 2 23 1 1 4
bacterial endocardts)
2) Normal cardiac functon 1 ı 1%
D) Impares cardiac funcion 2 CN RES >» 2
Carias ayas
2) Arta foren
D) Know eng QT syndrome
2) Non-migamous (mid or severe)
1 aa 1
>) Migraine without aura, at any age
) Mora y ap 7 x lal =
©) Migraine wth aura, at any age 1 EN EN ME
©) History (5 years ago) of migraine 4 a lel à x 3;
an ara. any age
cur? aaa
o 23021042 00012202 prove ras cay aan on onaapm coque robes moon
A D moss
tion © = Continuation
2) Uncomplicated 1 TA 1 1 2
b) Complicated (eg. pulmonary
hypertension, istry of subacute 2 23 1 1 4
bacterial endocardts)
2) Normal cardiac functon 1 ı 1%
D) Impares cardiac funcion 2 CN RES >» 2
Carias ayas
2) Arta foren
D) Know eng QT syndrome
2) Non-migamous (mid or severe)
1 aa 1
>) Migraine without aura, at any age
) Mora y ap 7 x lal =
©) Migraine wth aura, at any age 1 EN EN ME
©) History (5 years ago) of migraine 4 a lel à x 3;
an ara. any age
cur? aaa
o 23021042 00012202 prove ras cay aan on onaapm coque robes moon
A D moss
Ne
FSRH Rda.
UKMEC SUMMARY TABLE HORMONAL AND INTRAUTERINE CONTRACEPTION
Initiation, € = Continuation
"etopati ercraria hypertension cu) ME] JN E 3 1 2
Ep 1 SUN IE 1 1
Taking anti-epileptic drugs
BREAST AND REPRODUCTIVE TRACT CONDITIONS
Vaginal bleeding patterns
‘Geta antelope drug have the potential to area the
bcavalably of steroid hormones in hormonal contraception,
For update information on he potental aru interactions
between hormenal contraception and a-epieple drugs, please
retro tre online drug Iteracton Checker avalable on Socdey à
Interaction Checker webster na ons.
mslaerstumentinug-nerasbona him).
3) agua pater vito heavy Deedog | 1 2 | 2 2 1
D) Heawy o prlonged bleeding (nudes
er and regular patterns) 2 2 | 2 2 1
Unexplained vaginal bleeding
teta sn bere sali aaa
Endometriosis 2 A 7 1 a
Benign overen tumours (netting cy 1 ı [4 1 1 1
Severe dysmenorthowa 2 CN 1 1 1
Gestational trophoblastic disease
(ct)
2) Undetetable ho levels 1 ı Ir 1 1 1
D) Decreasing HCG levels 3 > [4 1 1 E
©) Persisenty elevated HCG levels or à
mahgnant disease a | 1 ' '
ana er PITA a ma nly aan MORE PO FS
FSRH Rda.
UKMEC SUMMARY TABLE HORMONAL AND INTRAUTERINE CONTRACEPTION
Initiation, € = Continuation
"etopati ercraria hypertension cu) ME] JN E 3 1 2
Ep 1 SUN IE 1 1
Taking anti-epileptic drugs
BREAST AND REPRODUCTIVE TRACT CONDITIONS
Vaginal bleeding patterns
‘Geta antelope drug have the potential to area the
bcavalably of steroid hormones in hormonal contraception,
For update information on he potental aru interactions
between hormenal contraception and a-epieple drugs, please
retro tre online drug Iteracton Checker avalable on Socdey à
Interaction Checker webster na ons.
mslaerstumentinug-nerasbona him).
3) agua pater vito heavy Deedog | 1 2 | 2 2 1
D) Heawy o prlonged bleeding (nudes
er and regular patterns) 2 2 | 2 2 1
Unexplained vaginal bleeding
teta sn bere sali aaa
Endometriosis 2 A 7 1 a
Benign overen tumours (netting cy 1 ı [4 1 1 1
Severe dysmenorthowa 2 CN 1 1 1
Gestational trophoblastic disease
(ct)
2) Undetetable ho levels 1 ı Ir 1 1 1
D) Decreasing HCG levels 3 > [4 1 1 E
©) Persisenty elevated HCG levels or à
mahgnant disease a | 1 ' '
ana er PITA a ma nly aan MORE PO FS
UKMEC SUMMARY TABLE HORMONAL AND INTRAUTERINE CONTRACEPTION
Initiation, € = Continuation
Carvicalscropion
‘Cervical intrapittal neoplasia (CIN)
3) Avating testment
D) Radical tracheleciony 3 2 |>2| 2 1 2
y | | ES O | > | 7 EE
D) Benign breast conditions 1 a 1 1 1
©) Famiy story of breast cancer 1 ı [4 1 1 1
(9 Carers of now gene mutations
associated with breast cancer (9 1 2 | 2 2 3
BROMIBRCAZ)
© Breas cancer
(0 Current breast cancer 1 A 4
(9) Pas breast cancer 1 313 3
1 1 1 1
1 1 1 1
cur? aaa
o 23021042 00012202 prove ras cay aan on onaapm coque robes moon
A D moss
Initiation, € = Continuation
Carvicalscropion
‘Cervical intrapittal neoplasia (CIN)
3) Avating testment
D) Radical tracheleciony 3 2 |>2| 2 1 2
y | | ES O | > | 7 EE
D) Benign breast conditions 1 a 1 1 1
©) Famiy story of breast cancer 1 ı [4 1 1 1
(9 Carers of now gene mutations
associated with breast cancer (9 1 2 | 2 2 3
BROMIBRCAZ)
© Breas cancer
(0 Current breast cancer 1 A 4
(9) Pas breast cancer 1 313 3
1 1 1 1
1 1 1 1
cur? aaa
o 23021042 00012202 prove ras cay aan on onaapm coque robes moon
A D moss
ACTE
UKMEC SUMMARY TABLE HORMONAL AND INTRAUTERINE CONTRACEPTION
Initiation, € = Continuation
3) Without orton ofthe uterine cauty | 1 1 1 1 1 1
D) With disen of the weine cai 3 > [+ 1 1 1
Anatomical abnormalities
2) Distorted uterine cavity a 3
D) Other abnormalities 2 2
Pelvic inflammatory disease (PID)
2) Past PID (assuming no current risk
{actor for STs)
1) Curent PID
Sexual transmitted infections (STIs)
a) Chlamydial infection (cure)
0 Smptomae
WAsmptomate
D Paren costs or gnoroon (oros) | 4 | 2 | #
©) ter ret STs (cti Bape) | 2 2
Gagne (nauéng Téhomonas gras | > 7
sndbactea vagos rer)
© Increased isk fr STIS 2 2 |ı 1 1 1
sow? EE ee PTT
E 2: yee 00022200 rovers easly amine artes my Do mama Meran
inane cece agent dor toa tenes Coca po, poc le e
‘nosh stay command we se ma appre aes ae mabe cele
UKMEC SUMMARY TABLE HORMONAL AND INTRAUTERINE CONTRACEPTION
Initiation, € = Continuation
3) Without orton ofthe uterine cauty | 1 1 1 1 1 1
D) With disen of the weine cai 3 > [+ 1 1 1
Anatomical abnormalities
2) Distorted uterine cavity a 3
D) Other abnormalities 2 2
Pelvic inflammatory disease (PID)
2) Past PID (assuming no current risk
{actor for STs)
1) Curent PID
Sexual transmitted infections (STIs)
a) Chlamydial infection (cure)
0 Smptomae
WAsmptomate
D Paren costs or gnoroon (oros) | 4 | 2 | #
©) ter ret STs (cti Bape) | 2 2
Gagne (nauéng Téhomonas gras | > 7
sndbactea vagos rer)
© Increased isk fr STIS 2 2 |ı 1 1 1
sow? EE ee PTT
E 2: yee 00022200 rovers easly amine artes my Do mama Meran
inane cece agent dor toa tenes Coca po, poc le e
‘nosh stay command we se ma appre aes ae mabe cele
UKMEC SUMMARY TABLE HORMONAL AND INTRAUTERINE CONTRACEPTION
Initiation, € = Continuation
2) High isk of HIV infection 1 1 1 1 7 1
D) HIV nie
10 GD4 count 2200 ces 2 27.1 E 1 1
(0) CDs count <200 call
1 1 1 1
DEEE
©) Taking antetroval (ARV) ange | Geran ARV drugs have the pote to aft ne bicavallablty of
‘Sared hormones in hormonal contracepin,
Forupto-date information on the potential drug interactions
between homenal contraception and ARV drugs, please refer to
the cnine HN drugs interaction checker
€ calles a)
2) Nompetie 7 7 1 1 7 1
D) Pome
ane 1 4 1
2) History of gestational disease 1 1 1 1 1 1
D) Nensascular dssase
Norman dependent E 2 [2] 2 2 2
{D Isuin dependent 1 2 [2] 2 2 2
©) Nephropamyireinopainymeuropamy | 1 2 [2] 2 2 3
à) Other vascular disease 1 2 |» 2 2 3
ERI aaa
SAMMI 5 a más ears wna Come por, ser sae te
Tan ch en a GEE a NS
Initiation, € = Continuation
2) High isk of HIV infection 1 1 1 1 7 1
D) HIV nie
10 GD4 count 2200 ces 2 27.1 E 1 1
(0) CDs count <200 call
1 1 1 1
DEEE
©) Taking antetroval (ARV) ange | Geran ARV drugs have the pote to aft ne bicavallablty of
‘Sared hormones in hormonal contracepin,
Forupto-date information on the potential drug interactions
between homenal contraception and ARV drugs, please refer to
the cnine HN drugs interaction checker
€ calles a)
2) Nompetie 7 7 1 1 7 1
D) Pome
ane 1 4 1
2) History of gestational disease 1 1 1 1 1 1
D) Nensascular dssase
Norman dependent E 2 [2] 2 2 2
{D Isuin dependent 1 2 [2] 2 2 2
©) Nephropamyireinopainymeuropamy | 1 2 [2] 2 2 3
à) Other vascular disease 1 2 |» 2 2 3
ERI aaa
SAMMI 5 a más ears wna Come por, ser sae te
Tan ch en a GEE a NS
SR
UKMEC SUMMARY TABLE HORMONAL AND INTRAUTERINE CONTRACEPTION
Initiation, € = Continuation
2) Simple gore 1 1 1 1 1
D) Hyperthyred 7 1 1 1 1 1
©) Hypo 1 1 1 1 1 1
2) Smptomate
(Treated by choleoytectomy 1 2 [2] 2 2 2
(W) Mesicaly treated 1 2 [2] 2 2 3
Mn Care 1 2 [2] 2 2 3
D) Asymptomatio 1 2 [2] 2 2 2
History of cholestasis
2) Pregnancy related E 1 1 E 1 2
D) Past COC related 1 2 [2] 2 2 3
2) Acute or fare
1 4 1 1 4
D} Carer 1 1 1 1 1 1
©) Chrono 1 1 1 1 1 1
2) Mid (compensated wihout
complications)
D} Severe (decompensated) E sts] 3 3 a
‘canton be CIO ven DA AS mm PONEN eA
UKMEC SUMMARY TABLE HORMONAL AND INTRAUTERINE CONTRACEPTION
Initiation, € = Continuation
2) Simple gore 1 1 1 1 1
D) Hyperthyred 7 1 1 1 1 1
©) Hypo 1 1 1 1 1 1
2) Smptomate
(Treated by choleoytectomy 1 2 [2] 2 2 2
(W) Mesicaly treated 1 2 [2] 2 2 3
Mn Care 1 2 [2] 2 2 3
D) Asymptomatio 1 2 [2] 2 2 2
History of cholestasis
2) Pregnancy related E 1 1 E 1 2
D) Past COC related 1 2 [2] 2 2 3
2) Acute or fare
1 4 1 1 4
D} Carer 1 1 1 1 1 1
©) Chrono 1 1 1 1 1 1
2) Mid (compensated wihout
complications)
D} Severe (decompensated) E sts] 3 3 a
‘canton be CIO ven DA AS mm PONEN eA
UKMEC SUMMARY TABLE HORMONAL AND INTRAUTERINE CONTRACEPTION
Initiation, € = Continuation
3) Benign
() Fosal nodular pers E 2 12] >» 2
(Wepstecasar adenoma. 1 3 |s| 3 3
D} Maignant (hepatoceluar carcinoma) | 1 3 E 3 3
€ : 1 la 1 2 2
a 4 1 1
A 1 1 2
2 ı 1 4 4
1 2 [2] 2 2 2
2) Noantphosphaipidanibadies 1 2
D) Positive aniphosphotpid antbodes.
Poskive artiphospholipid antibodies
DRUG INTERACTIONS.
Taking mediation
EERE ainda
o AA
Initiation, € = Continuation
3) Benign
() Fosal nodular pers E 2 12] >» 2
(Wepstecasar adenoma. 1 3 |s| 3 3
D} Maignant (hepatoceluar carcinoma) | 1 3 E 3 3
€ : 1 la 1 2 2
a 4 1 1
A 1 1 2
2 ı 1 4 4
1 2 [2] 2 2 2
2) Noantphosphaipidanibadies 1 2
D) Positive aniphosphotpid antbodes.
Poskive artiphospholipid antibodies
DRUG INTERACTIONS.
Taking mediation
EERE ainda
o AA
VFsRH msm.
SECTION C: REFERENCES AND RESOURCES
References... 103
Introduction. 103
Intrauterine Contraception (UC). 105
Progestogen-only Contraception (POC)... 120
Combined Hormonal Contraception (CHC). 36
Emergency Contraception (EC)... 62,
Additional Resources, 164
Diagnosis of Migraine With or Without Aura. 164
Appendices... 168
‚Appendix 1: UKMEC Development Process... és .. 168
Appendix 2: List of Contributors. 169
‘Appendix 3: Commonly Used Abbreviations... „172
SECTION C: REFERENCES AND RESOURCES
References... 103
Introduction. 103
Intrauterine Contraception (UC). 105
Progestogen-only Contraception (POC)... 120
Combined Hormonal Contraception (CHC). 36
Emergency Contraception (EC)... 62,
Additional Resources, 164
Diagnosis of Migraine With or Without Aura. 164
Appendices... 168
‚Appendix 1: UKMEC Development Process... és .. 168
Appendix 2: List of Contributors. 169
‘Appendix 3: Commonly Used Abbreviations... „172
REFERENCES
Introduction
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Introduction
1. er Healt Organization. Medical Elba Crore for Contraceptive Use (Sth edn). 2015. hp ne
Intreproducivenealpubicatons/amiy, planningMEC-Slen/ (accessed 8 Feb 2016]
2 Facut of Sens and Reproduive Heathcare. UK Mia! Ely Criteria fr Coactiva Use (UKMEC
2000). 2000. Ds AVEC 008 pt fccessed 8 Feb 2016]
3. Stephen G. Brechin S.Gasier A. Using forma consensus methods to adapt Wold Health Organization
Medical Eiglty Cte for Contraceptive Use. Contraception 2008, 78: 300-308.
4. Famiy Panning Assocation (pa) Contraception hap. in ia ca à ace
[accessed 8 Feb 2016)
5. Trusso J Contraceptive efeacy. In Hatcher RA, Trusel Nelson AL, e al (eds), Contraceptive
Technology (200 revised edn). New York NY: Ardent Meda, 2011
©. Centers fer Dase Cont nd Prevention (CDC) Etecienes of emily planing mods
Z ntendedoresnancuindfamiy-lanning 2 [accessed 8 Feb 2010]
7. Facuy of Sexual and Reproductive Heatncare. Drug Itractonswkh HomanalCotraception, 2012.11
sits shngasionstinmonal a faesessed 8 Feb 2016]
18. BM Group, ROPCH Publications Lid the Royal Pharmaceutical Society of Great Bian. Bish National
Fm * [nccesced 8 Feb 2016)
8. electron Mediines Compendium (eV). is ule accessed 8 Feb 2010]
10, _waruhivdrugineracons org. Drug Interaction Chats, I interactions orlnea
[accessed 8 Feb 2016),
1. MedenesCampleta, Stockleys Interaction Checker modchescomsice .
Shots [cressed 8 November 2017]
12, UK Teatlogy Information Sere (UKTIS). is IIS or faeessed 8 Fe 2016)
13 Fauna an Reproduce Hear, Barer ar Corte and Piotr 2012
un nor parie. accessed 8 Feb 2016)
| FSRH EEE
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a [accessed & Feb 2016]
Intrauterine Contraception (IUC)
1. Faculty of Sexual and Reproductive Healthcare Intrauterine Contraception. 2016. un.
an [accessed 8 Feb 2016)
2. Alber, Carasco F Duenas J, ot al Analysis of miner complcatonsin copper IUD wearers [n Spanish
Clinica e nvesigacion en Ginecologia y Obsttrca 1983: 10: 16-22
3. _Allonen H, Luukkanen , Nielsen NO, ta Two-year rates fr Nova T and Copper Tin a comparative study
(Contraception 1980; 24 321-334
4. Allongn H, Luukklnen T, Nielsen NC, tal Factors afin he neal perfomance of Nova T and Copper T
200, Obstet Gynec 1984; 64: 524-528,
5. Aten TM, Brock GN, Yang D, el Revospective review of intrauterino device in adclescent and young
‘women y Pediatr Adlese Gyneco 2012, 25: 195-200,
6. _ Behringer, Reeves MF, Rossier Be Duration of use ofa levonorgestrel US amongst nliparus and
adolescent women. Cortracption 2011 84: e5-010.
7. Berenson AB, Tan A. Hith JM. ot al Complcaion and continuation of intrauterine device use among
commercalynsired teenagers. Obstet Gynecol 2013 121: 951-088.
18. _LuukkainenT Alonen H, Nilsen NO, e al. Five years experience of intrauterine contraception with the
Nova T and the Copper-T-200. Am J Obstet Gynecol 198%, 147. 885-092
9. LuukkainenT, Nielsen NC, Nygren KG, a Nuliparous women, UD and pe infection. Am CinRes 1979;
een
10. LuukkalnenT, Nilsen NC, Nygren KG, et al Combined and national experience of pestmensta IUD
Insertions of tiova-T and CopperT à randomized study. Contraception 1979; 18 11-20
1. Nygren KG, Nielsen NC, PyrlaT, oa Inraterine contraception wth Nova-T and copperT-200 during
three years Contraception 1991 24: 520-542,
12, OsserS, Gulberg 8. Lieshem P, ea Rick ofpebic inflammatory disease amenginkraterine-device users
irespecive of previous pregnancy. Lancet 1860, 315 396-388
18, Rasheed SM, Abdeimonem AM, Complications among adolescents using copper inauteine contraceptive
devices. It J Gynacco! Obstet 2011 115: 269-272,
14. StajasK Dorp |, SkajaaT. Complcatons caused by intrauterine contraceptive devices. Ugeshr Langer
1980, 182: 3002-3008
1. Faculty of Sexual and Reproductive Healthcare Intrauterine Contraception. 2016. un.
an [accessed 8 Feb 2016)
2. Alber, Carasco F Duenas J, ot al Analysis of miner complcatonsin copper IUD wearers [n Spanish
Clinica e nvesigacion en Ginecologia y Obsttrca 1983: 10: 16-22
3. _Allonen H, Luukkanen , Nielsen NO, ta Two-year rates fr Nova T and Copper Tin a comparative study
(Contraception 1980; 24 321-334
4. Allongn H, Luukklnen T, Nielsen NC, tal Factors afin he neal perfomance of Nova T and Copper T
200, Obstet Gynec 1984; 64: 524-528,
5. Aten TM, Brock GN, Yang D, el Revospective review of intrauterino device in adclescent and young
‘women y Pediatr Adlese Gyneco 2012, 25: 195-200,
6. _ Behringer, Reeves MF, Rossier Be Duration of use ofa levonorgestrel US amongst nliparus and
adolescent women. Cortracption 2011 84: e5-010.
7. Berenson AB, Tan A. Hith JM. ot al Complcaion and continuation of intrauterine device use among
commercalynsired teenagers. Obstet Gynecol 2013 121: 951-088.
18. _LuukkainenT Alonen H, Nilsen NO, e al. Five years experience of intrauterine contraception with the
Nova T and the Copper-T-200. Am J Obstet Gynecol 198%, 147. 885-092
9. LuukkainenT, Nielsen NC, Nygren KG, a Nuliparous women, UD and pe infection. Am CinRes 1979;
een
10. LuukkalnenT, Nilsen NC, Nygren KG, et al Combined and national experience of pestmensta IUD
Insertions of tiova-T and CopperT à randomized study. Contraception 1979; 18 11-20
1. Nygren KG, Nielsen NC, PyrlaT, oa Inraterine contraception wth Nova-T and copperT-200 during
three years Contraception 1991 24: 520-542,
12, OsserS, Gulberg 8. Lieshem P, ea Rick ofpebic inflammatory disease amenginkraterine-device users
irespecive of previous pregnancy. Lancet 1860, 315 396-388
18, Rasheed SM, Abdeimonem AM, Complications among adolescents using copper inauteine contraceptive
devices. It J Gynacco! Obstet 2011 115: 269-272,
14. StajasK Dorp |, SkajaaT. Complcatons caused by intrauterine contraceptive devices. Ugeshr Langer
1980, 182: 3002-3008
ACTE
5.
46,
".
s.
».
2
Suhonen S, Haukkamaa M, Jakcbsson T,e al Ciicl perfomance of a evonergesveleleasing intrauterine
system and oral conraceptvesin young nulparous women: a compare study. Cortracepton 2004. 6;
sora
Zhang J. Feldblum PA CALI ta Risk factors frapper UD expulsion an epidemioogi anat.
“Contraception 166246: 427-453.
Deans El, Grimes DA. Itrauteine devices for adolescents: a systematic review. Contraception 200% 70:
sean.
aus R. Lo P, Prager S. Use ofthe Mirena LNG-US and Paragard CvT380A intrauterine devices in
ridiparous women, Board of the Society of Family Planning. Contraception 2010, BY: 267-371
Sonakar 5, Kapp N. Itrauterine device insertion inthe postpartum period a systematic review. Eur J
(Cortracept Reprod Heath Gare 2015.20: 4-18
CHIC, Wiens L. Rogers S. Expulsionsin immediate postpartum insertions of Lippes Loop D and Copper Y
IUDS and ther esinterpart Data devices an epidemiclogal analysis, Contraception 1995, 32: 116-134
Momsen ©, Waszak C Kate K, eJal incl cutcomes of two early postpartum IUD insert programs in
‘Mea. Coniacepton 1006, 63-17-21
ErogluK Alu G. Vural, al Comparison of fe} and complications of UD insertion in immediate
postlacentalleary postpartum period with terval period 1 year falowup. Cortracoption 206. 7: 376-381
Heinemann K, Reed, Mochner Set al. Risk of uterine peroration wah levonorgestrlreeasing and copper
irrauterine devices inthe European Acive Suneitance Study en Irauerine Devices. Contraception 2015
91 774-207,
Chen BA, Reeves MF, Grain MD. ota Postlacental or deayed levonorgestrel intrauterine device insertion
and breastfeeding duration, Contracesion 2011. 84: 499-504.
‘ito MB, Feria RA, Cuetana SM, et al Safety ofthe etenogestrtelesing implant during the immediate
Postpatum perio ape study. Contraception 2009; 80: 510-526,
‘Gurtehelf SE, Turok DK, Stoddard G, tal Lactogeness after early postpartum use ofthe contraceptive
implant randomized controled tal Obstet Gynecol 201% HZ: HMC
{Gahamondes L, Bahamandes MV, Modesto W ot al Efecto hormonal contraceptives dung breastfeeding
on ia mikingestion and growth. Feri Ste 2013; 100: 46-450
‘Costa ML. Cecati 16, Krupa FG, ta. Progestironly contraception prevents bone loss in postpartum
breastfeeding women. Contraception 2012.88: 374-280,
5.
46,
".
s.
».
2
Suhonen S, Haukkamaa M, Jakcbsson T,e al Ciicl perfomance of a evonergesveleleasing intrauterine
system and oral conraceptvesin young nulparous women: a compare study. Cortracepton 2004. 6;
sora
Zhang J. Feldblum PA CALI ta Risk factors frapper UD expulsion an epidemioogi anat.
“Contraception 166246: 427-453.
Deans El, Grimes DA. Itrauteine devices for adolescents: a systematic review. Contraception 200% 70:
sean.
aus R. Lo P, Prager S. Use ofthe Mirena LNG-US and Paragard CvT380A intrauterine devices in
ridiparous women, Board of the Society of Family Planning. Contraception 2010, BY: 267-371
Sonakar 5, Kapp N. Itrauterine device insertion inthe postpartum period a systematic review. Eur J
(Cortracept Reprod Heath Gare 2015.20: 4-18
CHIC, Wiens L. Rogers S. Expulsionsin immediate postpartum insertions of Lippes Loop D and Copper Y
IUDS and ther esinterpart Data devices an epidemiclogal analysis, Contraception 1995, 32: 116-134
Momsen ©, Waszak C Kate K, eJal incl cutcomes of two early postpartum IUD insert programs in
‘Mea. Coniacepton 1006, 63-17-21
ErogluK Alu G. Vural, al Comparison of fe} and complications of UD insertion in immediate
postlacentalleary postpartum period with terval period 1 year falowup. Cortracoption 206. 7: 376-381
Heinemann K, Reed, Mochner Set al. Risk of uterine peroration wah levonorgestrlreeasing and copper
irrauterine devices inthe European Acive Suneitance Study en Irauerine Devices. Contraception 2015
91 774-207,
Chen BA, Reeves MF, Grain MD. ota Postlacental or deayed levonorgestrel intrauterine device insertion
and breastfeeding duration, Contracesion 2011. 84: 499-504.
‘ito MB, Feria RA, Cuetana SM, et al Safety ofthe etenogestrtelesing implant during the immediate
Postpatum perio ape study. Contraception 2009; 80: 510-526,
‘Gurtehelf SE, Turok DK, Stoddard G, tal Lactogeness after early postpartum use ofthe contraceptive
implant randomized controled tal Obstet Gynecol 201% HZ: HMC
{Gahamondes L, Bahamandes MV, Modesto W ot al Efecto hormonal contraceptives dung breastfeeding
on ia mikingestion and growth. Feri Ste 2013; 100: 46-450
‘Costa ML. Cecati 16, Krupa FG, ta. Progestironly contraception prevents bone loss in postpartum
breastfeeding women. Contraception 2012.88: 374-280,
a
a
2,
‘Shaamash AH, Sayed GH, Hussien MM. et al A comparative study of the Ievonorgesirereleaing nrautrine
system Mirena versus the Copper T380A ntrauterine device dufng lactation: Beasteedng perbrmance
infant grom and infant development, Contraception 2005, 72: 346-351,
Elsedeek MS. Puerperal and menstrual bleeding pateo difren types of contraceptive device ted
ing elective cesarean deber) Int J Gynoecal Obstet 2012: 116: 31-3.
Okusanya BO, Oduwele 0, Efa EE. Immediate postabortal insertion ofinvauterine devices. Cochrane
Database Sys Rev 2014; 7: 0001777
El Tagy A Sak, Sokal DC, Issac AH, Safety and acceptably of post bora UD insertion andthe importance
of counseling. Conracepion 2003; 67: 229-294.
Moussa A. Evaluation ofpostabrtion UD insertion in Egyptian women. Contraception 2001; 68: 315-317.
Timonen H, LuukkinenT. Inmediate postaborion insertion ofthe copper (TCw-200) wi eigen mente
falowp, Contraception 1974 9: 153° 160,
(Gupta |, Deu PK. Studies on immediate pos-aborion copper T device. Inn J Med Res 1975, 63: 736-
78.
Susan, LähleenmäkiP Detaled analysis o menstrual Bleeding pates afer postmensrual and
postaborta insertion of à copper IUD er a levenergesvelleasng intrauterino system. Conrception 1996,
‘54201-2008
‘Stanwood NL, Grimes DA, Schule KF.Inserion o an intrauterine contraceptive device ater induced or
sportaneous abortion: areview ofthe evidence BJOG 2001; 108: 1108-1173.
Pakañnen P Toivonen J LukkainenT. Randomized comparison of levonorgestrel: and cepperleasing
inraterine systems immediately ater abortion wih 5 years Tlo-up. Contraception 2008, 68: 31-34,
Gites PG, Lee NH, Yuzpe AA, ta A comparison ofthe efícacy and aceptaity ofthe Copper?
Itratenne device foloning mente e delayed inserion ae est trmenter herapeuteaboricn. Fai
‘Sten 1980 34: 121-124
Zhang PZ Five years experience with he copper 200 in Shanghai 866 cases. Contraception 1980; 22:
seen
Vlr Heath Organization's Special Programme of Research Development and Research Training in Human
Reproducien: Task Force en intrauterino Devices for Fallty Regulaton. UD inserto flowing spontaneous
aborion a inca tial efthe TCu 200, Lippes lop D, and copper 7. Stud Fam Plann 1083: 18: 109-114.
Wirk Heath Organization's Special Programme of Research Development and Research Training in Human
a
2,
‘Shaamash AH, Sayed GH, Hussien MM. et al A comparative study of the Ievonorgesirereleaing nrautrine
system Mirena versus the Copper T380A ntrauterine device dufng lactation: Beasteedng perbrmance
infant grom and infant development, Contraception 2005, 72: 346-351,
Elsedeek MS. Puerperal and menstrual bleeding pateo difren types of contraceptive device ted
ing elective cesarean deber) Int J Gynoecal Obstet 2012: 116: 31-3.
Okusanya BO, Oduwele 0, Efa EE. Immediate postabortal insertion ofinvauterine devices. Cochrane
Database Sys Rev 2014; 7: 0001777
El Tagy A Sak, Sokal DC, Issac AH, Safety and acceptably of post bora UD insertion andthe importance
of counseling. Conracepion 2003; 67: 229-294.
Moussa A. Evaluation ofpostabrtion UD insertion in Egyptian women. Contraception 2001; 68: 315-317.
Timonen H, LuukkinenT. Inmediate postaborion insertion ofthe copper (TCw-200) wi eigen mente
falowp, Contraception 1974 9: 153° 160,
(Gupta |, Deu PK. Studies on immediate pos-aborion copper T device. Inn J Med Res 1975, 63: 736-
78.
Susan, LähleenmäkiP Detaled analysis o menstrual Bleeding pates afer postmensrual and
postaborta insertion of à copper IUD er a levenergesvelleasng intrauterino system. Conrception 1996,
‘54201-2008
‘Stanwood NL, Grimes DA, Schule KF.Inserion o an intrauterine contraceptive device ater induced or
sportaneous abortion: areview ofthe evidence BJOG 2001; 108: 1108-1173.
Pakañnen P Toivonen J LukkainenT. Randomized comparison of levonorgestrel: and cepperleasing
inraterine systems immediately ater abortion wih 5 years Tlo-up. Contraception 2008, 68: 31-34,
Gites PG, Lee NH, Yuzpe AA, ta A comparison ofthe efícacy and aceptaity ofthe Copper?
Itratenne device foloning mente e delayed inserion ae est trmenter herapeuteaboricn. Fai
‘Sten 1980 34: 121-124
Zhang PZ Five years experience with he copper 200 in Shanghai 866 cases. Contraception 1980; 22:
seen
Vlr Heath Organization's Special Programme of Research Development and Research Training in Human
Reproducien: Task Force en intrauterino Devices for Fallty Regulaton. UD inserto flowing spontaneous
aborion a inca tial efthe TCu 200, Lippes lop D, and copper 7. Stud Fam Plann 1083: 18: 109-114.
Wirk Heath Organization's Special Programme of Research Development and Research Training in Human
ACTE
#.
si
Reproduction: Task Force on intrauterino Devices for Fey Regdaton UD insetion along termination
ofpregnancy a ciel tial ofthe Tou 2200, Lppes loop D. and copper 7. Stud Fam Plann 1863: 14: 9
os,
Vi Heath Organization's Special Programme of Research Development and Research Training in Human
Reproduction; Task Force cn intrauterino Devices or Fent Regalen The Alza TIPOS 52, longer
acing progesterone IUD: safety and efcacy compared ne TCU2200 and muticad 250 n two randomized
mullente tials. Clin Reprod Fert 1983, 2: 113-128.
Hohmann HL. Reeves ME, Chen BA, ot al Inmedate versus delayed insertion of the levenorgestel-eleasing
Intrauterine device foloving dation and evacution randomized controled tal. Corracepion 2012 6:
240-245
Saav. Stephansson ©, Gemzelh Danielson K. Early versus delayed inserton ofintrauterine contraception
ater medial aberton a randomized controlled na, PLOS One 2012: 7: 48048,
(Cremer 4, Bullard KA, Mosley RM, ot al Inmediato ve. delayed post abrtal copper T 380A VD inertion in
cases over 12 weeks of gestation. Contraception 2011.83: 822-527.
‘Bednarek PH, Ceinin MD, Reeves MF, ot al Inmediato versus delayed IUD inserion alerte aspiration
Eng Med 2011; 364 2208-2217.
Betstad SJ, Turok OK. Kapp N, a al nrauterine device insertion ater medealaborion. Contraception 2011
Bu 517-823,
rey EA, Reeves MF, Ogawa DD, et al.Insrton ofinrauteine contacepives immediatly flowing fst: and
stoandiimester aborions. Cortracption 2009; 79: 307-402.
‘Shimoni NA, Davis A. Ramos ME, ea. Tning of copper intrauterino device inseton afer mesial abortion:
randomized cores ial. Obstet Gynecol 201: 18: 623-028
Met , Dobson A, Beaglehoe tal Rapid reduction on coronary ik for those who qui cigarette
smoking, ust NZ JPuble Heath 1006, 22: 787-191
Rosenberg R, Palmer JR, Shape 5. Decne inthe isk ofmyocardal inacción among women wh stop
smoking, N Engl Med 1060, 322 213-217
enfield SA, Stampfer Mu, Rosner BA. Smoking and smoking cesaton in rlation to mortal in women,
LAMA 2008: 29: 2087-2047.
Fong YF. Singh K Etfect ofthe levonergesteeleasng intrauterine system on eine myomasin a renal
transplan patent. Contraception 1909, 60: 51-53
Zeme J, Do KL, Drewry J a rauterine contraceptive device flues in renal transplant patient.
Roprod Med 1981: 26: 99-102.
#.
si
Reproduction: Task Force on intrauterino Devices for Fey Regdaton UD insetion along termination
ofpregnancy a ciel tial ofthe Tou 2200, Lppes loop D. and copper 7. Stud Fam Plann 1863: 14: 9
os,
Vi Heath Organization's Special Programme of Research Development and Research Training in Human
Reproduction; Task Force cn intrauterino Devices or Fent Regalen The Alza TIPOS 52, longer
acing progesterone IUD: safety and efcacy compared ne TCU2200 and muticad 250 n two randomized
mullente tials. Clin Reprod Fert 1983, 2: 113-128.
Hohmann HL. Reeves ME, Chen BA, ot al Inmedate versus delayed insertion of the levenorgestel-eleasing
Intrauterine device foloving dation and evacution randomized controled tal. Corracepion 2012 6:
240-245
Saav. Stephansson ©, Gemzelh Danielson K. Early versus delayed inserton ofintrauterine contraception
ater medial aberton a randomized controlled na, PLOS One 2012: 7: 48048,
(Cremer 4, Bullard KA, Mosley RM, ot al Inmediato ve. delayed post abrtal copper T 380A VD inertion in
cases over 12 weeks of gestation. Contraception 2011.83: 822-527.
‘Bednarek PH, Ceinin MD, Reeves MF, ot al Inmediato versus delayed IUD inserion alerte aspiration
Eng Med 2011; 364 2208-2217.
Betstad SJ, Turok OK. Kapp N, a al nrauterine device insertion ater medealaborion. Contraception 2011
Bu 517-823,
rey EA, Reeves MF, Ogawa DD, et al.Insrton ofinrauteine contacepives immediatly flowing fst: and
stoandiimester aborions. Cortracption 2009; 79: 307-402.
‘Shimoni NA, Davis A. Ramos ME, ea. Tning of copper intrauterino device inseton afer mesial abortion:
randomized cores ial. Obstet Gynecol 201: 18: 623-028
Met , Dobson A, Beaglehoe tal Rapid reduction on coronary ik for those who qui cigarette
smoking, ust NZ JPuble Heath 1006, 22: 787-191
Rosenberg R, Palmer JR, Shape 5. Decne inthe isk ofmyocardal inacción among women wh stop
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5.
or
kerengpageski 1, marcado 5 rat MR Lal Ex nd contraceptive eos arid
USheplantation In women. Transplant Proc 2004, 36; 1405-1486. jé =
(Denne D. Contraception inthe female transplant recipe, Dil Transplant 1986; 15: 010-612.
Kingman CE, Kadk RA, Lee CA, el a The use ofthe levenergesti-eleasing itrautene system for
treatment of manorrhagian women wth inherted Bleeding order. 8/00 2004, 11H: 1425-1428,
Pisoni CN, Cuadrado Md, Khamashta MA, e al Treatment of menorhagia associated wäh oral
anticoagulation: eficacy and sata of the levonorgestrel leasing niratere device Mirena cl). Lupus
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management of menorhagia in women with hemortabe disorders. Am J Obstet Gynecol 2005, 103 1361
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rich National Fomulary (one). 7.3.1. Combined hormonal contraceptives. i
a [accessed & Feb 2016)
Vi O, Robertson L, Twaddle S, et a Screening fr hrombophla in highs situations: a meta-analysis
and costetfecveness analy Br J Haematol 2008; 131: 80-00,
Mádidrop Svan Hylckama Vieg A. Does thrombophilia testing help in te clinical management of
Pants? Br Haomalol 2008; 43: 321-095,
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378,
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ik factors of nomatal venousIrömboembolem. Tromb Haomas 1996; 79: 26-31
‘Azar J, Mia Y. Vaya A, tal Factor V Leiden and prothrembin G202104 muationsin young aduts wih
yplogeneIschaemi sche. Tromb Haemost 2004; St: 1051-1054
Bennet, Odeberg H Resistance to activated protein C highly prevalent amongst users of ral
conracepives wih vencustivomboembas. ner Med 1998; 24: 27-22
Elcemerkamp KW. Rosendaal FR, Helmerhort FM, ta. Enhancement by factor V Leiden mutation of
"isk deep ven thrombosis associated wth oral contraceptives conahing athd- generation progestagen.
[Comment] Lancet 1995, 46: 1593-1598
or
kerengpageski 1, marcado 5 rat MR Lal Ex nd contraceptive eos arid
USheplantation In women. Transplant Proc 2004, 36; 1405-1486. jé =
(Denne D. Contraception inthe female transplant recipe, Dil Transplant 1986; 15: 010-612.
Kingman CE, Kadk RA, Lee CA, el a The use ofthe levenergesti-eleasing itrautene system for
treatment of manorrhagian women wth inherted Bleeding order. 8/00 2004, 11H: 1425-1428,
Pisoni CN, Cuadrado Md, Khamashta MA, e al Treatment of menorhagia associated wäh oral
anticoagulation: eficacy and sata of the levonorgestrel leasing niratere device Mirena cl). Lupus
2006. #5: 877-280,
Schande ZE. Dolan G, Powell MC. The use ofthe levonorgesrlreleasing intrauterine system nthe
management of menorhagia in women with hemortabe disorders. Am J Obstet Gynecol 2005, 103 1361
ES
rich National Fomulary (one). 7.3.1. Combined hormonal contraceptives. i
a [accessed & Feb 2016)
Vi O, Robertson L, Twaddle S, et a Screening fr hrombophla in highs situations: a meta-analysis
and costetfecveness analy Br J Haematol 2008; 131: 80-00,
Mádidrop Svan Hylckama Vieg A. Does thrombophilia testing help in te clinical management of
Pants? Br Haomalol 2008; 43: 321-095,
Blckstein D,Blesein | Oral contraception andttrombophiia. Cr Opin Obstet Gynecol 2007; 18: 370-
378,
Anderson BS, Olen J, Nilsen GL, et al Third generation oral contracentives and hertable thrombophilia as
ik factors of nomatal venousIrömboembolem. Tromb Haomas 1996; 79: 26-31
‘Azar J, Mia Y. Vaya A, tal Factor V Leiden and prothrembin G202104 muationsin young aduts wih
yplogeneIschaemi sche. Tromb Haemost 2004; St: 1051-1054
Bennet, Odeberg H Resistance to activated protein C highly prevalent amongst users of ral
conracepives wih vencustivomboembas. ner Med 1998; 24: 27-22
Elcemerkamp KW. Rosendaal FR, Helmerhort FM, ta. Enhancement by factor V Leiden mutation of
"isk deep ven thrombosis associated wth oral contraceptives conahing athd- generation progestagen.
[Comment] Lancet 1995, 46: 1593-1598
ACTE
ni
7
=.
78,
a
Blcemerkamp KW, Rosendaal FR, Hlmerhorst FM, a al Higher sk of vencus thrombosis during early
use of eal contraceptives in women wih inhrted cating defects. [Comment Arch Iter Med 2000, 160:
en
de Brun SF. Stam J, Koopman MM, e a Case-contl study fr of erebal sus thvombessin oral
(onracaptve users and in [earecton ot who re] carers ofheredtary prohrambole conditions. The
Cerebral Venous Sus Trombosis Study Group. BMJ 1608; 316: 686-202
Emmerich J, Rosendaal FR, Cattaneo M, tal Combined effec of factor V Leiden and protombin 202108
onthe risk of venous tremboambalsm - posed analysis of case-contra studies including 2310 cases and
3204 contols Study Grup or Pooled Analysis in Venous Thromboembolism. Thromb Haemost 2001; 86:
vo.
adela T, Andre C, ica AA, ot a. Prtwembin 202104 and oral contraceptive use as ik factors for
cerebral venous thrombosis, Cerebrovase Dis 2005; 19: 40-52
Legnani ©, Plarei 6. Guazzaoca 6, tal Venous thromboembolism in young women: role fthrobophile
mations and ral contraceptive use. Eur Heart J 2002 23: 804-990,
Marine, SaceiE, Landi G ta. High ik of corebral-vein vembosis in cars of a pretivambie-gene
ration and in uses o oral contraceptives, [Comment] N Engl Med 1008; 338 1703-1707.
Marini, Tae E, Buccirel Pe al Interaction between he G20210A mutation ofthe rehrambin gene
and ea contacepive usen des ven tirambosis.Artenoecer rom Vaso Ba 1999.19: 700-703,
Marina, BattaglotT, Gucciael Pt a Rik factors and recurrence rat of primary deep ven trombosis
ofthe upper extremes. Circulation 2008; 110: 886-870
Marine, Battaga ©. Burgo 1e al Ora contraceptive use, thrombophilia and ther interaction in young
women wth schaemie sroke, Haematolegia 2006 94: 844-847.
Madeldorp 5. Meinard JR, Koopman MM, e lA prospective study of asymptomatic carers ofthe actor V
Leiden mutation o determine he incidence of venous Iromboembeiem. (Comment). Am ner Med 201
As: ar.
abinger |, Schnee B. Thrombote ak of women with heredar anihrembin I ren C- and pte
Sdefzienty taking eral contraceptive medcaton, The GTH Study Group on Natura Inmblrs.Tiromo,
Haemost 1804: 74 518-582
Pezzii A, Grass M,lacovl Le a. Inherted thrombophilia and stratification of ischaomi stoke risk
among users of orl conraceptives J Neurol Neurosurg Payet 2007 78: 271-270
‘Santamaria A, Mateo J, OfverA oa. Risk oftrombosis associated with oral contraceptives of women fom
97 famlies wi inherited thrombophilia igh ik of rombesis in carers ofthe G20210A mutation ofthe
prativombin gene. Masmateogíca 200; 6: 905-871.
ni
7
=.
78,
a
Blcemerkamp KW, Rosendaal FR, Hlmerhorst FM, a al Higher sk of vencus thrombosis during early
use of eal contraceptives in women wih inhrted cating defects. [Comment Arch Iter Med 2000, 160:
en
de Brun SF. Stam J, Koopman MM, e a Case-contl study fr of erebal sus thvombessin oral
(onracaptve users and in [earecton ot who re] carers ofheredtary prohrambole conditions. The
Cerebral Venous Sus Trombosis Study Group. BMJ 1608; 316: 686-202
Emmerich J, Rosendaal FR, Cattaneo M, tal Combined effec of factor V Leiden and protombin 202108
onthe risk of venous tremboambalsm - posed analysis of case-contra studies including 2310 cases and
3204 contols Study Grup or Pooled Analysis in Venous Thromboembolism. Thromb Haemost 2001; 86:
vo.
adela T, Andre C, ica AA, ot a. Prtwembin 202104 and oral contraceptive use as ik factors for
cerebral venous thrombosis, Cerebrovase Dis 2005; 19: 40-52
Legnani ©, Plarei 6. Guazzaoca 6, tal Venous thromboembolism in young women: role fthrobophile
mations and ral contraceptive use. Eur Heart J 2002 23: 804-990,
Marine, SaceiE, Landi G ta. High ik of corebral-vein vembosis in cars of a pretivambie-gene
ration and in uses o oral contraceptives, [Comment] N Engl Med 1008; 338 1703-1707.
Marini, Tae E, Buccirel Pe al Interaction between he G20210A mutation ofthe rehrambin gene
and ea contacepive usen des ven tirambosis.Artenoecer rom Vaso Ba 1999.19: 700-703,
Marina, BattaglotT, Gucciael Pt a Rik factors and recurrence rat of primary deep ven trombosis
ofthe upper extremes. Circulation 2008; 110: 886-870
Marine, Battaga ©. Burgo 1e al Ora contraceptive use, thrombophilia and ther interaction in young
women wth schaemie sroke, Haematolegia 2006 94: 844-847.
Madeldorp 5. Meinard JR, Koopman MM, e lA prospective study of asymptomatic carers ofthe actor V
Leiden mutation o determine he incidence of venous Iromboembeiem. (Comment). Am ner Med 201
As: ar.
abinger |, Schnee B. Thrombote ak of women with heredar anihrembin I ren C- and pte
Sdefzienty taking eral contraceptive medcaton, The GTH Study Group on Natura Inmblrs.Tiromo,
Haemost 1804: 74 518-582
Pezzii A, Grass M,lacovl Le a. Inherted thrombophilia and stratification of ischaomi stoke risk
among users of orl conraceptives J Neurol Neurosurg Payet 2007 78: 271-270
‘Santamaria A, Mateo J, OfverA oa. Risk oftrombosis associated with oral contraceptives of women fom
97 famlies wi inherited thrombophilia igh ik of rombesis in carers ofthe G20210A mutation ofthe
prativombin gene. Masmateogíca 200; 6: 905-871.
a
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ttromboembofem in women with ange or mue tombophie defect: results fom aretrospetv family
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Ischaemic stroke Trromi Haemost 2005, 3 1213-1217.
‘Spannag! M Heinemann LA, Sram W Are factor V Leiden caries who ue oral contraceptives at
extreme risk of venous trombemboter? Eur J Contracept Reprod Heath Care 2000, 5: 108-112
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"ak of hrombeasin falls whined antithrombin deficiency. Blood 1569 4: 2590-2504
van Vimen EF, Brouwer JL, Veeger NJ. tal Oral contraceptives andthe absolut ik of venous
ttromboembofem in women with ange or mue tombophie defect: results fom aretrospetv family
cohort stay Arch tom Med 2007. 167: 282-260.
Vandenbroucke JP, Koster, Bit E, a al neeased risk of venus hrombossin orakconracepive users
‘wo ae cares of factor V Leiden mutation. [Comment], Lance 1989; 344; 1453-1457,
Vaya AM. Protronbin 620210A mutaton aná oral contraceptive use increase upper-eemity deep vein
tomb ick Trom Haomos 2003, 89: 452-487
Royal Colege of General Prattenes Oral Cetraception Study. Oral contraceptive, venous Inombosis
And vacose vine, JR Col Gen Pract 1978; 192: 399-200,
Roach RE, Lfering WM, van Hyekama Mig A, ot al The ik of venous trombosis inndviduas with a
history o superiil vin trombosis and acquired venous hrembate risk factors. Blood 2013; 12: 4264—
428.
Medscape. Cardiology. io en ¡e contrario fcgessed 8 Fe 2018)
Faculty of Senual and Reproductive Heathcare. Cortacoptie Choice for Women with Cardiac Disease
2014, saldo 2 5
[acoessed 8 Feb 2016),
National Inte for Heath and Care Excellence (NICE), Prophyauis Against infective Endocaris:
‘Antimeobil Prophyfans Agaıs Ici Endocarditis in Adatz and Chen Undergoing Itenertionsl
Procedures, 2008 Bui 22% [accessed 8 Feb 2016)
Ava WS, Grinberg M Melo NR. al al Contraceptive use in women wth hear disease [in Portuguese) Arg
‘ras Card 1096: 66: 205-211
Sur V, Aggarwal N, Kaur Re a Safety onraueine contraceptive device (copper T 2008) in women wih
cardiac disease. Contraception 2008; 78: 315-318,
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Obstet Gynecol 2010, 2° 55-65.
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Bear
sre O, Tr B Treatment of menorhagia wäh the levonorgestrel trauterne system versus endometia
resection Feri Stor 200%; 76: 904-309,
Koh SC, Singh K. The efecto evonorgestereleasing intrauterine system use on menstrual blood oss and
the hemosate, frinaiytesnhtter systems in women wth menerhaga. Thromb Haemost 2007, 5: 53
13,
Lathaby A, Hussin M Rshwerth JR e al Progesterone o progestogen leasing intrauterine systems for
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103,
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Obstet Gynecol 2010, 2° 55-65.
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Classieaton of Headache Disorders, 3d eatin (beta version) Gophali 2013; 3: 529-808
MedicnesComplee, Stockley’ interaction Checker - »
CE accessed 9 November 2017]
Naonalinsiue of Heath an Care Excelence, Heavy Mens Blacng Assessment and Mansgemet
2007. cas a i accessed 8 Feb 2016)
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ap: Ft eripasICEUGudanceProbiematcBleedingHeronalContracepton pal accessed 8 Feb
208
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contraceptive. Contaception 2002 66: 303-300
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Database Syst Rev 2008, 4: CD002120.
Barington JU Arunkalahanan AS, Abde-Faltah M. Comparison between the levonorgesr nrauterine
system (LAGAUS) and thermal balcon ablation in the treatment ofmenorhagi. Eur y Obst! Gynecol
Repro Bil 2003; 408: 72-74.
‘Gupta B, ital 5, Msra Ral. Levonorgestrel releasing inrateine sytem vs, transcerdcal endometral
resection fr dysundional terne bleeding. Im Gynaecol Obstet 2008, 0: 291-288.
HurstainenR. Teper J. RissanenP ot al Quaty lt and cost-efeciveness oflevonorgesre-rlasing
Intrauterine system versus hysereiomy fr tesiment of menonhagi: a randomised til Lancet 2001: 357:
Bear
sre O, Tr B Treatment of menorhagia wäh the levonorgestrel trauterne system versus endometia
resection Feri Stor 200%; 76: 904-309,
Koh SC, Singh K. The efecto evonorgestereleasing intrauterine system use on menstrual blood oss and
the hemosate, frinaiytesnhtter systems in women wth menerhaga. Thromb Haemost 2007, 5: 53
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gestational rophobasti disease. Corracopion 2008 8; 369-371
nice use among women wih
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‘oor: 78: 199-198,
110. Stewart, Cummins C, Gold L, et al The efectveness ofthe levoncrgesretrelasng intrauterino system in
rmenerthagia: a systematic review. 8106 2001; 108: 74-88
‘11. FedeleL, Bianchi S,ZanconateG. of al Use ofa levonergetebrleasng intrauterine device in the treatment
ofrecovaginal endometteas, Fort Ste 200%: 75: 405-468,
112. Lock FOE. The elect ofa levencrgestal intrauterine system (LNG-IUS) on symptomatic endometriosis.
Fen Sten 2002, 77: S24,
413. Pelta CA, Femani RA, Abrao MS, tal Randomized cnial nal ofa levenorgesteleleasing intrauterino
‘system anda depot GnRH analogue fr te testment ofchran pelvis pain women wih endometioas,
ur Reprod 2005, 20: 1903-1068
114. Verein. imi G, Panazza S, et al Alewonorgesrtreleaig intrauterino system forthe treatment of
(ysmenorhea associated with endometriosis: pt study. Fort Sten! 199, 72: 505-608,
115. VercliniP. Fontine 6, De GO, ot al Comparison of alevanergestrlrelasing intrauterine device versus
‘expectant management ater conservative surgery fr symptomatic endometoss a plo! study Fert Stor
2008; 80: 305-208,
116. Ho Yuen 8, Burch P Rlabonship of oral contraceptives andthe intrauterine contraceptive devices othe
régression of concerraton of ne beta subuni of human cherioie enadatopin and vasive complications
“er molar pregnancy, Am J Obstet Gynecol 1083: 445: 214-217
117. Adewole IF, Oladekun A, Fawole AO, et al Fett reguatry maths and development of completions
ater evaciaton of complete hydatlorm mele. J Obstet Gynaecol 2000.20: 68-60.
418. Deica RE, Miler DS, Radmaker AW. et The ole of contraception inthe development of postmoar
trophoblasi tumour. Obstet Gynecol 1001: 78: 221-228.
119. Gañeld ME, Kapp, Cutis KM. Combined oral cenracepive and inrautrn
gestational rophobasti disease. Corracopion 2008 8; 369-371
nice use among women wih
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‘fameless intrautetnelevonorgestrebreeasng drug delivery system: a lot study Eur J Obstet Gynecol
Reprod Bil 2002; 402: 74-79.
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Inrauteine system: fects on ovarian funcio and es. Arch Gynecol Obstet 2008, 280: 20-42
AndabanjerK Taneepanichkul S. The use of levonorgestrl-UD nthe treatment of uterine myoma in Thai
‘women. J Med Arco Thai 2006; 8 8147-8151
Rosa E Siva JC, de Sa Rosa e Silva AC, Candido dos Reis FJ, ea Use of esonorgestetrelesing
inraterine device for he somplomati treatment of uterine myomae. J Reprod Med 2008; 50: 613-817
Merci F, De SR, Di Spiezio SA, ofa The elect ofa levoncrgestrl-eeasng intrauterine device inthe
treatment of myomarrelated menomhapa. Contraception 2003, 67: 277-280,
Grigoriewa Y. Cher Mok M, Tarasova M, et a. Use of lovonorgetetreeasing intrauterino system to treat
bleeding related o uterine ilompomas. Fert Sten 2008 79: 196-1198
‘Starezewshi A, hvanic M Itauteine therapy with levonorgestrel releasing UD of women with
hypemencerea secondary to uterine reds fn Pash) Ginekl Pol 2000, 74: 1221-1225.
‘Soysl S, Soysl ME. The afcscy flevenorgestrl-eeasing inrauterne device in selected cases of myoma-
related menernap a prospective conrled tial Gynecol Obata Inv 2005: 59: 29-35,
‘hom A, Mansel E, Spence-Jones C ea. Treatment of menorhaga withthe levonorgestrel intrauterine
‘system: can we lar rom cur fates? J Obstet Gyneco 2000.20: 630-691
Larsson B, Wennergren M. Investigation ofa copperinrautrine device (Cu UD) for possible eet on
frequency and healng of pele infammatory disease, Contraception 1877: 15: 143-148
Soderberg, Undoten 5. nfuence of an intrauterino device onthe course ofan acute pet nfammatey
disease. Contraception 198%; 24: 137-143,
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Urban university cnc Am J Obstet Gynecol 2007; 197: 19301-10306.
137. Cropsey KL, Matthews C, Campbel 5. ta Long-term, reversible cenracepton use among high women
treated n a unversty-bacea gyneclogy cc comparison between IUD and depo-provera. J Womens
Heath Lard) 2010, 9: 348-353.
138. Faundes A, Teles E, Coole ML, ta The risk ofinadvertentitrauterine device insertion in women
ames of endocenical Chema trachomatis. Covtracepton 199; 38: 105-108,
180, Ferraz do LagoR, Smoes JA, Bahamondes Lt al Folowup of users ofnrauteine device wth and without
bacterial vapinosis and eer carvcovaginal infections, Contraception 2008 68: 108-100
140. Mohlajee AP. Cutis KM, Peterson HB. Does nseton and use ofan intrauterine device increase the sk
fpelveinfammatory disease among women win soul transmite fecton? A systematic review.
(Contraception 2008 13: 145-183.
141. Morison CS, Sekadde-Kigend C, Miler WC, al Use of sexu transmite disease isk assessment
garth fr seecton oitrauterne device candidates. Contraception 1008, 50: 97-106
142. Pap-Akeson M, Saheim F, Thor ©, ta Genta rat infections associated th the intrauterine
contraceptive device can be reduced by inserting he treads ito Ihe uterine cay. Br J Obstet Gynecol
1992 96: 676-679,
143, Sine SK, Schule KF, Lampley PR, e al Preventing IUCD-eated pele infection: the eficacy ofprophtale
doxyeyaine al nserion Br J Obstet Gynasca 1000; 97: 412-418.
144. Sjeldestad FE, Halvorsen LE, Kahn Hat. 1UD users in Norway are at ow ik for gentalC trachomatis
Infection. Cotracpten 196; 4: 200-212.
145. Walsh TL, Bemstein GS, Grimes DA ta Et of prophylactic anbitics on morbidly associated wih UD
insern:resuts of pict randomized corral tal. 1UD Study Group. Contraception 199 80: 319-327.
146. CaraelM. Van de Pere PH, Lepage PH tal Human immunodeficiency vs transmission among
heterosenual coupes in Cental Aten, ADS 1988 2: 201-208.
147, European Study Group on Heterosexual Transmission of HIV. Comparison o female to male and male to
female ransmision of HV in $63 stale couples. BMY 1982; 304: 808-813,
148, Mann JM, NedambiN,Piot P, et al HI infection and associated ak factors in female protein Kinshasa,
Zaire AIDS 1988; 2346-254,
ACTE
1.
15.
151
152,
1.
154
155,
18
#7.
1.
15.
wm.
12.
Kapiga SH, Lyamuya EF, Lviula GK, ta. The incidence o HIV infection among women using family
Planning methcás in Dar es Salaam, Tanzanía. AIDS 1066, 12: 75-84
Kapiga SH, Shao JF Lua GK. et al Ric actors for HIV infection among women in Dares Salaam,
Tanzania. J qui mune Def Syndr 1994: 7 301-200
Marin HL. J Nyange PM, Richardson BA, et al Hormonal coriracepbon, sexual tansmites diseases, and
Fisk heterosexual transmision of human immunodefeiency vis type 1.4 Infos Dis 1868, 178: 1059-1058.
Mat JK Hunter DJ, Maggwa BN, al. Contracepive use andthe ek of HIV infection in Nae, Kenya. Int
{Gynecol Obstet 196548: 61-87.
Nicolosi A. Corea Lee ML, Muscco»4, a. The effcency of male-to-female and femaleto-male sexual
transmision of he human inmunedefiency vue a study 01730 table couples. Ratan Study Group on HIV
Heterosenual Transmission Coment, Epidemiology 1294 5: 570-675,
Plourd PA, Plummer FA, Pepin. ta. Human inmunodefeieney vrs type infection in women attending a
senualy transmitted diseases ini in Kenya. [Comment] Y infect Dis 1992, 166: 88-02
‘Sine SK. Forty JA, Kgondu CS. et al Contraceptive use and HIV infection in Kenyan family planning cnc
tenders, Int STO AIDS 1996; 7: 65-70
‘Spence MR, Rebbine St, Polansky M. et a. Seroprevaance of human Immunodefieney veus type NET)
antbodesinafamty-panning population, Sex Transm Dis 1881; 18: 142-145,
Mosad SB, Overbaugh J, Devange DM, el Hormonal contraception, vtamin À deitncy, and other ak
factors or shedding of HIV-infected cals om the cendx and vagina Lance 1007: 390: 022-027
Sine SK. Marion cs, Sekaddel Kigondy C tai Complcaton of use ofinravtene devices among HIV-1
Infected women Lancet 1098: 351: 1220-1241.
Richardson BA, Morison CS, Sekaddek Kigondy ©, et al Etc o intrauterino device use on cervical
sheng of Het ONA AIDS 1060; 13: 2081-2097.
Kovacs A, Wasserman SS, Bums D, a a Determinants of HN: shedding nthe genital rat of women,
{Lancet 2001; 358: 1599-1801
Monson CS, Selkaddek-Kigond C, Sn SK, ofa Ihe invautrine device appropriate contraception or
HIV infected women? 8,06 2007 108: 784.700.
Hekinneimo O, LehtovtaP, Sun J, ta. The levonergestre-eleasing intrauterine system (NGAUS) in HV:
Infected women — effects on bleeding pattems, ovarian funcion and genial shedding of HIV. Hum Repved
2006 21: 2287-2861
1.
15.
151
152,
1.
154
155,
18
#7.
1.
15.
wm.
12.
Kapiga SH, Lyamuya EF, Lviula GK, ta. The incidence o HIV infection among women using family
Planning methcás in Dar es Salaam, Tanzanía. AIDS 1066, 12: 75-84
Kapiga SH, Shao JF Lua GK. et al Ric actors for HIV infection among women in Dares Salaam,
Tanzania. J qui mune Def Syndr 1994: 7 301-200
Marin HL. J Nyange PM, Richardson BA, et al Hormonal coriracepbon, sexual tansmites diseases, and
Fisk heterosexual transmision of human immunodefeiency vis type 1.4 Infos Dis 1868, 178: 1059-1058.
Mat JK Hunter DJ, Maggwa BN, al. Contracepive use andthe ek of HIV infection in Nae, Kenya. Int
{Gynecol Obstet 196548: 61-87.
Nicolosi A. Corea Lee ML, Muscco»4, a. The effcency of male-to-female and femaleto-male sexual
transmision of he human inmunedefiency vue a study 01730 table couples. Ratan Study Group on HIV
Heterosenual Transmission Coment, Epidemiology 1294 5: 570-675,
Plourd PA, Plummer FA, Pepin. ta. Human inmunodefeieney vrs type infection in women attending a
senualy transmitted diseases ini in Kenya. [Comment] Y infect Dis 1992, 166: 88-02
‘Sine SK. Forty JA, Kgondu CS. et al Contraceptive use and HIV infection in Kenyan family planning cnc
tenders, Int STO AIDS 1996; 7: 65-70
‘Spence MR, Rebbine St, Polansky M. et a. Seroprevaance of human Immunodefieney veus type NET)
antbodesinafamty-panning population, Sex Transm Dis 1881; 18: 142-145,
Mosad SB, Overbaugh J, Devange DM, el Hormonal contraception, vtamin À deitncy, and other ak
factors or shedding of HIV-infected cals om the cendx and vagina Lance 1007: 390: 022-027
Sine SK. Marion cs, Sekaddel Kigondy C tai Complcaton of use ofinravtene devices among HIV-1
Infected women Lancet 1098: 351: 1220-1241.
Richardson BA, Morison CS, Sekaddek Kigondy ©, et al Etc o intrauterino device use on cervical
sheng of Het ONA AIDS 1060; 13: 2081-2097.
Kovacs A, Wasserman SS, Bums D, a a Determinants of HN: shedding nthe genital rat of women,
{Lancet 2001; 358: 1599-1801
Monson CS, Selkaddek-Kigond C, Sn SK, ofa Ihe invautrine device appropriate contraception or
HIV infected women? 8,06 2007 108: 784.700.
Hekinneimo O, LehtovtaP, Sun J, ta. The levonergestre-eleasing intrauterine system (NGAUS) in HV:
Infected women — effects on bleeding pattems, ovarian funcion and genial shedding of HIV. Hum Repved
2006 21: 2287-2861
163. Stinger EM, Kasaba C, Leu Je a A randomized bal ofthe intrauterine contraceptive device vs hormonal
‘contraception in women who are infected with the human Inmunodefency vrs. Am J Obstet Gynecol 2007:
antun.
164. Lehtovta P,Paavenen J, Heikinheimo O. Experience wth the levenorgetreleleasing Inrauterne system
among HWVinfeced women. Contracaptón 2007. 75: 37-39.
105, Kake O, Byamugisha JK, Tumwesigye NM, tal Ciicl versus laboratory sereening or sexy
transmitted nfecions pie to insertion of irauterne contraception among women hing wth HIVIAIDS: à
Fandemized cones Wal. Hum Reprod 2018; 30: 1973-1979,
166, Hekinneim O, Lehtovta P, Aho et ai Te lvonorgestrteleaing intrauterino system in human
Immunodatisency vineinfcted women: a year flowup study, Am J Obstet Gynecol 201; 204: 12681
‘el,
167. I Dragateraction org. Dru Interaction Chas id era orne aso
[acoessed 8 Feb 2018]
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1 diabetes: à randomized tal, Obstet Gynecol 2005; 105: 811-815.
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‘melts. Gynecol Enaoerinel 2009; 22: 198-208,
170. GinesP, Quintero E, AroyoV, tal Compensated cehoss: natural history e prognosi factors Hepatalagy
1987.7 122-128.
171. Bematsky 5, Ramsey Goldman Gordon C, tal Factors associated wth abnomal Pap rests in systemic
lupus eynemalosus Rheumatology (Oxford) 2004; 43: 1386-1380
172. Bematsky 5, Clarke A, Ramsey Goiéman Re al Hormonal exposures and breast cancer ina sample of
"women with systemic lupus erythematosus, Rheumatology (On 2004 4: 1178-1181,
173. Chopra, Keren S, Greer WA ta. Factor Leiden, prothrombin gene mutton, and thrombosis kin
Patients wth antphospholid abodes. J Rheumatol 2002; 2: 1883-1688,
174, Esdale JM, Abrahamoniez M, Grodeiky Ta Tadtinal Framingham ak factors ito fly account tr
accelerated alherosderosis in systemic pus exytematosus,Ativtis Rheum 2001; 84: 2331-2537,
175, Salunen HA, Oral contraceptives in systemic lupus enthematosus: side-effects and infuence onthe ay
ISLE, Scand J Rhoumatal 1991 20: 427.438
‘contraception in women who are infected with the human Inmunodefency vrs. Am J Obstet Gynecol 2007:
antun.
164. Lehtovta P,Paavenen J, Heikinheimo O. Experience wth the levenorgetreleleasing Inrauterne system
among HWVinfeced women. Contracaptón 2007. 75: 37-39.
105, Kake O, Byamugisha JK, Tumwesigye NM, tal Ciicl versus laboratory sereening or sexy
transmitted nfecions pie to insertion of irauterne contraception among women hing wth HIVIAIDS: à
Fandemized cones Wal. Hum Reprod 2018; 30: 1973-1979,
166, Hekinneim O, Lehtovta P, Aho et ai Te lvonorgestrteleaing intrauterino system in human
Immunodatisency vineinfcted women: a year flowup study, Am J Obstet Gynecol 201; 204: 12681
‘el,
167. I Dragateraction org. Dru Interaction Chas id era orne aso
[acoessed 8 Feb 2018]
168. RogovskayaS, Rivera R, Grimes DA, ta Effect ofa levonorgestrel intrauterine system on women wth ype
1 diabetes: à randomized tal, Obstet Gynecol 2005; 105: 811-815.
169. Grigoryan OR. Groéniskaya EE, Andreeva EN, otal. Coriraceplln in perimenopausal women with diabetes
‘melts. Gynecol Enaoerinel 2009; 22: 198-208,
170. GinesP, Quintero E, AroyoV, tal Compensated cehoss: natural history e prognosi factors Hepatalagy
1987.7 122-128.
171. Bematsky 5, Ramsey Goldman Gordon C, tal Factors associated wth abnomal Pap rests in systemic
lupus eynemalosus Rheumatology (Oxford) 2004; 43: 1386-1380
172. Bematsky 5, Clarke A, Ramsey Goiéman Re al Hormonal exposures and breast cancer ina sample of
"women with systemic lupus erythematosus, Rheumatology (On 2004 4: 1178-1181,
173. Chopra, Keren S, Greer WA ta. Factor Leiden, prothrombin gene mutton, and thrombosis kin
Patients wth antphospholid abodes. J Rheumatol 2002; 2: 1883-1688,
174, Esdale JM, Abrahamoniez M, Grodeiky Ta Tadtinal Framingham ak factors ito fly account tr
accelerated alherosderosis in systemic pus exytematosus,Ativtis Rheum 2001; 84: 2331-2537,
175, Salunen HA, Oral contraceptives in systemic lupus enthematosus: side-effects and infuence onthe ay
ISLE, Scand J Rhoumatal 1991 20: 427.438
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ve,
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lupus eythemalosus. Anis Rheum 1862 25: 618-623.
Manz, Mela EN, Rabie JE, ell Age-speaie incidence rates of myocar infarction and angina in
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as,
MeAindonT, Glannlta L, Tau N, tal Envronmentl factors predicting nephris in systemic pas
ytnemalosus. Ann Rhoum Dis 1883,82: 720.724.
MeDona J Stewart .Urowiz MB, al Peripheral vascular disease in patents with systemic pus
ytnematosus Ann Rheum Dis 1962; 51: 56-60,
Mintz G,Guterrez G, Deeze M,e a. Contraception wih progestogens in systemic lupus eytematosus.
(Contraception 1864; 30: 28-38.
Pet. Musculoskeletal compleatons of systemic lupus enthemalosusin the Hopkins Lupus Cohort: an
update Anis Care Res 195, 8: 137-145,
Pet. Kim MY, Kalunan KC, el. Combined oral conracepives in women wth system pus
yihematosus. N Engl Med 205, 363: 2550-2558,
Pet ML Lupus in Batimore: evidence-based ‘clinical pearls fom the Hopkins Lupus Cohat. Lupus 2005; 14:
970-873
‘Sanchez-Guerero J, Uribe AG, Jimenez-Santan L tal. À tal of eonraceptve methods in women with
system lupus ernematosus. N Engl J Med 2005 353: 2539-2548,
‘Sarabi 28, Chang E, Bobba Rol al Incidence ats atra and venous remboss aer diagnosis of
system Lpus erythematosus, Arts Rheum 2005, 5: 609-612,
Schaedel ZE, Dolan G, Powell MC. The use of the levonorgestrlreleasing intrauterine system
‘management of menorhaga in women with hemostato disorders Am J Obstet Gynecol 2005. 18
cs
the
ter
‘Somers E Magder LS, Petri M Artphospnlpidantbodies and incidence of venous hromboss in a cohort of
patients wth systeme lupus erythematosus. J Rheumatol 2002; 2: 2531-2596,
Urowtz MB, Bookman AA, Koehler BE, ot al The bimodal moralty pato o systemic lupus erythematosus.
Am à Med 1978; 60: 221-222,
ve,
m.
we.
mm.
m.
181
m
se.
m.
108.
8.
7.
1.
1.
ulunen HA, Kaa R Friman ©. Contraceptive practice in women with systemic lupus erythematosus. Br
Rheumatol 1995; 32: 327-200.
dangers P. Dougados M, Pelle C e al. Infuence of ral contaceptive therapy onthe ati of systemic
lupus eythemalosus. Anis Rheum 1862 25: 618-623.
Manz, Mela EN, Rabie JE, ell Age-speaie incidence rates of myocar infarction and angina in
"women wih systemic lupus erythematosus: comparison withthe Framingham Stuy. Am J Epideml 1997;
as,
MeAindonT, Glannlta L, Tau N, tal Envronmentl factors predicting nephris in systemic pas
ytnemalosus. Ann Rhoum Dis 1883,82: 720.724.
MeDona J Stewart .Urowiz MB, al Peripheral vascular disease in patents with systemic pus
ytnematosus Ann Rheum Dis 1962; 51: 56-60,
Mintz G,Guterrez G, Deeze M,e a. Contraception wih progestogens in systemic lupus eytematosus.
(Contraception 1864; 30: 28-38.
Pet. Musculoskeletal compleatons of systemic lupus enthemalosusin the Hopkins Lupus Cohort: an
update Anis Care Res 195, 8: 137-145,
Pet. Kim MY, Kalunan KC, el. Combined oral conracepives in women wth system pus
yihematosus. N Engl Med 205, 363: 2550-2558,
Pet ML Lupus in Batimore: evidence-based ‘clinical pearls fom the Hopkins Lupus Cohat. Lupus 2005; 14:
970-873
‘Sanchez-Guerero J, Uribe AG, Jimenez-Santan L tal. À tal of eonraceptve methods in women with
system lupus ernematosus. N Engl J Med 2005 353: 2539-2548,
‘Sarabi 28, Chang E, Bobba Rol al Incidence ats atra and venous remboss aer diagnosis of
system Lpus erythematosus, Arts Rheum 2005, 5: 609-612,
Schaedel ZE, Dolan G, Powell MC. The use of the levonorgestrlreleasing intrauterine system
‘management of menorhaga in women with hemostato disorders Am J Obstet Gynecol 2005. 18
cs
the
ter
‘Somers E Magder LS, Petri M Artphospnlpidantbodies and incidence of venous hromboss in a cohort of
patients wth systeme lupus erythematosus. J Rheumatol 2002; 2: 2531-2596,
Urowtz MB, Bookman AA, Koehler BE, ot al The bimodal moralty pato o systemic lupus erythematosus.
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Syndrome wth pregnancy merbidly. Tom Haemost 2005; 96: 937-341.
Mais, Locahin MD, AtsumiT, ta Itemainal consensus statement on an update of te lasieation
cera or definite aniphosphalpid syndrome. J Thom Haemos 2006 4: 295-308
Evidence for Contraceptive Options and HIV Outsomes (ECHO) Til Consortium. HIV incidence among
‘women using intramuscular dept medtoryprogesirone acetate a copper nrauerino device, or a
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ACTE
so,
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Facut ofSowua and Reproductive Heatheare. Progestogemonty implant, 2014. alo
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Facuty of Sexual and Reproductive Heatncare,Pogestogeroiy Inecabe Contraception. 2014.
nat Aoi accessed & Feb 2016]
Fey of Sens nd Reproduce Hatha, Proesogenany Fis. 205. nora
a accessed à Feb 2018]
Korver, Kipping €, HegerMahn D, tal Maintenance of ation tibio withthe 75 micro desogestrel
only eoneaceptve pi (Crazete fer scheduled 12 delay in tablet intake, Cortracoption 2008, 7: 8-13.
National Insitute for Heath and Cinical Excelence (NICE) Langacting Reversible Coriracoption: The
_Eecine and Approprite Use of Long acting Reversible Contraception 2005.
ua pt facessed 8 Feb 2010]
Facut of Senual and Reproductive Heathcate, Cartracetie Chales for Young People. 2010. Mtn
{ath eqppatscauGuidancevoungPeople2010-pfaccessed 8 Feb 2018]
Vier Heath Organization Task Force fr Epidemioogcal Research on Reproductive Heath Special
Programme of Research, Develcpment and Research Trang in Human Reprogucton.Progestogen-only
Contraceptives During Lactation Infant Growth. Contraception 1804 0: 25-53,
Mais SL, Nommser-Rivers LA, Dewey KG. Determinants of exclusive breastfeeding in a conor of
Prmiparous perurban Peron mothers. J Hum Lact 2012: 28: 45-54
MeEwan JA, Joyce ON, Tothill AU, of al Eary experience in contraception wth anew progestogen,
(Contraception 1877; 16: 339-350.
‘ahamondes L, Bahamendes Ml, Modesto W e al Electo hormonal contaceptves during breastfeeding
On ntants mikingesin and growth, Fo ton! 2013, 100: 445-450,
ito MB, Feria RA, Quntana SM et a Safety of he etonogestreleasing impla during the inmediato
Ppespartum pes: plc study. Contraception 2009, 80: 519.628,
‘rome EA, Femandez ID, Fisher SG, tal The efec ol mmedte postpartum depot medronyprogesterone
‘on early brestísedng cessation. Contraception 201% 87: 836-043.
Chen BA, Reeves MF, Grain MD. ot aL Posplacetal or delayed levenorgestra intrauterine device insertion
and breastfeeding duration. Contraception 2011 4: 489-504
so,
12
».
Facut ofSowua and Reproductive Heatheare. Progestogemonty implant, 2014. alo
Sestoaston| plans. accessed 8 Feb 2016]
Facuty of Sexual and Reproductive Heatncare,Pogestogeroiy Inecabe Contraception. 2014.
nat Aoi accessed & Feb 2016]
Fey of Sens nd Reproduce Hatha, Proesogenany Fis. 205. nora
a accessed à Feb 2018]
Korver, Kipping €, HegerMahn D, tal Maintenance of ation tibio withthe 75 micro desogestrel
only eoneaceptve pi (Crazete fer scheduled 12 delay in tablet intake, Cortracoption 2008, 7: 8-13.
National Insitute for Heath and Cinical Excelence (NICE) Langacting Reversible Coriracoption: The
_Eecine and Approprite Use of Long acting Reversible Contraception 2005.
ua pt facessed 8 Feb 2010]
Facut of Senual and Reproductive Heathcate, Cartracetie Chales for Young People. 2010. Mtn
{ath eqppatscauGuidancevoungPeople2010-pfaccessed 8 Feb 2018]
Vier Heath Organization Task Force fr Epidemioogcal Research on Reproductive Heath Special
Programme of Research, Develcpment and Research Trang in Human Reprogucton.Progestogen-only
Contraceptives During Lactation Infant Growth. Contraception 1804 0: 25-53,
Mais SL, Nommser-Rivers LA, Dewey KG. Determinants of exclusive breastfeeding in a conor of
Prmiparous perurban Peron mothers. J Hum Lact 2012: 28: 45-54
MeEwan JA, Joyce ON, Tothill AU, of al Eary experience in contraception wth anew progestogen,
(Contraception 1877; 16: 339-350.
‘ahamondes L, Bahamendes Ml, Modesto W e al Electo hormonal contaceptves during breastfeeding
On ntants mikingesin and growth, Fo ton! 2013, 100: 445-450,
ito MB, Feria RA, Quntana SM et a Safety of he etonogestreleasing impla during the inmediato
Ppespartum pes: plc study. Contraception 2009, 80: 519.628,
‘rome EA, Femandez ID, Fisher SG, tal The efec ol mmedte postpartum depot medronyprogesterone
‘on early brestísedng cessation. Contraception 201% 87: 836-043.
Chen BA, Reeves MF, Grain MD. ot aL Posplacetal or delayed levenorgestra intrauterine device insertion
and breastfeeding duration. Contraception 2011 4: 489-504
4
45,
4.
w.
1%.
».
2
(Costa ML. Cecati JG, Krupa FG, et al Progesin-onty contraception prevent bone loss in pospartum
breastfeeding women. Contraception 2012.88: 374-380.
atibergK. Some eects of depo mesranyprogeserone acetate (OMPA): observations nie nursing infant
and in long term user IJ Gynaecol Obstet 1982 20: 43-48,
laz S, Reyes MY, Zepeda A, ta. Noplant® implants and progesterone vaginal ings do na fect matemal
bone tumor and densty during lactation and ater wearing, Hum Reprod 1900; 14 2400-2508,
Espey E, Ogbum T, Leeman, tal Efecto progestin compared wah combined era contraceptive pis on
Tact’ a randomized controled tis, Obstet Gynecol 2012 110: 5-13.
Gurtche SE. Turok DK, Stoddard G, et al Lactogeness after early postpartum use ofthe contraceptive
implat randomized controled tial Obstet Gynecol 2011, 17. HITA
Karmal | Hetau F,Ghonem Me al Circa biochemical, and experimental studies on lactation. Ciel
‘ects of gestagens en lactato Am J Obst! Gynecol 1009 105: 324-534
arataisongT.Yencit C, Gray R. The long-term grouth and development of ehren exposed to Depo
Provera auting pregnancy oralen. Comracepton 1902, 48: 313-3924,
Zafar J, AguleraE. Mui G, ta. Et ofa long-acting contraceptive progestogen on lactation. Obstet
‘Gynecol 1976; A7: 174-176.
AbdetAleem H, Abot youn ESM, Shaaban MM, et al The use ofnomegestra acetate subdermal
‘contraceptive implant, unplant during lactation. Contraception 1996.54: 281-288.
Aula KA, Ewan SI, Salem HS, a al Efecto early postpartum use ofthe contraceptive implants,
NORPLANT, on the serum levee of immunoglobulins ofthe mothers and ther breasted infants, Contaception
1985, 32 201-290
Mad 8, Kamadbraa S, Pinarteno J, ea. ect of Norplant on meters andinfants in the postartum
etd. Ad Contraco 1986 2: 371-380,
BaheraeiA.Ardsetani N. Ghazizadeh SH. Effects of progestogen-only contraceptives on breast-feeding and
Infant grow. re J Gynaocal Obstet 200; 74: 203-208.
jamadatir RI, CotredsdatirH, Sigurdardotr Kat al Comparative study ofthe ete of a progestogen:
only pllcontaing desogestrel and an intrauterino contraceptive device in lacaing women. BOG 2001 108:
rente.
yah Fac o Sex! and apr done Huan m
45,
4.
w.
1%.
».
2
(Costa ML. Cecati JG, Krupa FG, et al Progesin-onty contraception prevent bone loss in pospartum
breastfeeding women. Contraception 2012.88: 374-380.
atibergK. Some eects of depo mesranyprogeserone acetate (OMPA): observations nie nursing infant
and in long term user IJ Gynaecol Obstet 1982 20: 43-48,
laz S, Reyes MY, Zepeda A, ta. Noplant® implants and progesterone vaginal ings do na fect matemal
bone tumor and densty during lactation and ater wearing, Hum Reprod 1900; 14 2400-2508,
Espey E, Ogbum T, Leeman, tal Efecto progestin compared wah combined era contraceptive pis on
Tact’ a randomized controled tis, Obstet Gynecol 2012 110: 5-13.
Gurtche SE. Turok DK, Stoddard G, et al Lactogeness after early postpartum use ofthe contraceptive
implat randomized controled tial Obstet Gynecol 2011, 17. HITA
Karmal | Hetau F,Ghonem Me al Circa biochemical, and experimental studies on lactation. Ciel
‘ects of gestagens en lactato Am J Obst! Gynecol 1009 105: 324-534
arataisongT.Yencit C, Gray R. The long-term grouth and development of ehren exposed to Depo
Provera auting pregnancy oralen. Comracepton 1902, 48: 313-3924,
Zafar J, AguleraE. Mui G, ta. Et ofa long-acting contraceptive progestogen on lactation. Obstet
‘Gynecol 1976; A7: 174-176.
AbdetAleem H, Abot youn ESM, Shaaban MM, et al The use ofnomegestra acetate subdermal
‘contraceptive implant, unplant during lactation. Contraception 1996.54: 281-288.
Aula KA, Ewan SI, Salem HS, a al Efecto early postpartum use ofthe contraceptive implants,
NORPLANT, on the serum levee of immunoglobulins ofthe mothers and ther breasted infants, Contaception
1985, 32 201-290
Mad 8, Kamadbraa S, Pinarteno J, ea. ect of Norplant on meters andinfants in the postartum
etd. Ad Contraco 1986 2: 371-380,
BaheraeiA.Ardsetani N. Ghazizadeh SH. Effects of progestogen-only contraceptives on breast-feeding and
Infant grow. re J Gynaocal Obstet 200; 74: 203-208.
jamadatir RI, CotredsdatirH, Sigurdardotr Kat al Comparative study ofthe ete of a progestogen:
only pllcontaing desogestrel and an intrauterino contraceptive device in lacaing women. BOG 2001 108:
rente.
yah Fac o Sex! and apr done Huan m
ACTE
ey
m
Coutinho EM, Athayde ©, Dantas C oa Use ofa single implant of elcometine(ST-1435) a nonoraly active
progesin, as along acting cortraceplve fr pospartum nursing women. Contraception 1889, 58: 115-122.
(Croato HB, Diaz S, Peralta O, e al. Festty regulation in nursing women. I. Comparative perfomance of
progesterone implants vers placebo and copper Y. Am J Obstet Gynoca 1982 144: 201-206,
laz 5, Peralta O, Juez G, et al Fert regulation n nursing women Vi. Influence of NORPLANT
levonoigesrl implants upon lactation and infant growth, Contraception 1985; 32: 52-74
laz S, Peralta O, Juez G, otal, Fartity regulation in nursing women. VI Contraceptive effectiveness of
subdetmal progesterone mplant. Contraception 1984; 30: 311-325.
Diaz S, Zepeda A, Maturana Xf al Feri regulation in nursing women. IX. Contraceptive perfomance,
‘uration of station, infant grout, and bleeding pattems during us of progesterone vaginal tgs. progestin
‘onl ps. Norplant implants, and Copper T 380 miratein devices. Cortracopion 1987.56: 222-232.
Giner Va, Cortés GV, Sotelo LA al ect o daly ral administration of 0:50 mg of norethindrone en
lactation and on the composition of mik. Ginecol Obst Mex 1076, 40: 31-30
(Got, Ibara-Poo A, Zahat Je al fect o contraception on lactation. Am J Ostet Gynecol 1974: 118:
2
alderman LD, Nelson AL. Impact of erly postpartum administration of progestinony homonal
contracepives compared with nenneemonalcorracepves on short breast Teedng pers. Am J
(Obstet Gynecol 2002 186: 1260-1258.
Hannon PR, Ouggan AK, Servint JR, ota. The nfuence o medroxyprogeterane onthe duration of breast
feeding in mothers an urban community. Arch Pediatr Ados Mod 1867. 151: 480-400
Hekéla M. Luukkanen T. Duration ofbreastfeeding and development of cikren after insertion of a
levonorgesret releasing intrauterine contacepive device, Contraception 1882.28: 279-202.
‘ämenez J, Ochoa M, Soler MP, tal Longtem follow of children breastfed by mothers receiving depot
tmedronyprogesterone acetate, Contraception 1984: 30 822-533,
Kamal HefnawiF, Ghoneim Ma al. Ciria biochemical, and experimental studies en lactation. V inca
‘fects f ere onthe nation of ala. Am J Obstet Gynecol 1970, 108: 656-658.
Karim M, Ammar REI Mahgoub S, e al jected progestogen and lactation. Br Med. 1971; : 200-203.
Massal MR Diaz S. Quinteros El al. Contracepive eficacy and clinical perormance ofNestorene implants
in postpartum women. Cotracopton 2001.84: 308-378.
ey
m
Coutinho EM, Athayde ©, Dantas C oa Use ofa single implant of elcometine(ST-1435) a nonoraly active
progesin, as along acting cortraceplve fr pospartum nursing women. Contraception 1889, 58: 115-122.
(Croato HB, Diaz S, Peralta O, e al. Festty regulation in nursing women. I. Comparative perfomance of
progesterone implants vers placebo and copper Y. Am J Obstet Gynoca 1982 144: 201-206,
laz 5, Peralta O, Juez G, et al Fert regulation n nursing women Vi. Influence of NORPLANT
levonoigesrl implants upon lactation and infant growth, Contraception 1985; 32: 52-74
laz S, Peralta O, Juez G, otal, Fartity regulation in nursing women. VI Contraceptive effectiveness of
subdetmal progesterone mplant. Contraception 1984; 30: 311-325.
Diaz S, Zepeda A, Maturana Xf al Feri regulation in nursing women. IX. Contraceptive perfomance,
‘uration of station, infant grout, and bleeding pattems during us of progesterone vaginal tgs. progestin
‘onl ps. Norplant implants, and Copper T 380 miratein devices. Cortracopion 1987.56: 222-232.
Giner Va, Cortés GV, Sotelo LA al ect o daly ral administration of 0:50 mg of norethindrone en
lactation and on the composition of mik. Ginecol Obst Mex 1076, 40: 31-30
(Got, Ibara-Poo A, Zahat Je al fect o contraception on lactation. Am J Ostet Gynecol 1974: 118:
2
alderman LD, Nelson AL. Impact of erly postpartum administration of progestinony homonal
contracepives compared with nenneemonalcorracepves on short breast Teedng pers. Am J
(Obstet Gynecol 2002 186: 1260-1258.
Hannon PR, Ouggan AK, Servint JR, ota. The nfuence o medroxyprogeterane onthe duration of breast
feeding in mothers an urban community. Arch Pediatr Ados Mod 1867. 151: 480-400
Hekéla M. Luukkanen T. Duration ofbreastfeeding and development of cikren after insertion of a
levonorgesret releasing intrauterine contacepive device, Contraception 1882.28: 279-202.
‘ämenez J, Ochoa M, Soler MP, tal Longtem follow of children breastfed by mothers receiving depot
tmedronyprogesterone acetate, Contraception 1984: 30 822-533,
Kamal HefnawiF, Ghoneim Ma al. Ciria biochemical, and experimental studies en lactation. V inca
‘fects f ere onthe nation of ala. Am J Obstet Gynecol 1970, 108: 656-658.
Karim M, Ammar REI Mahgoub S, e al jected progestogen and lactation. Br Med. 1971; : 200-203.
Massal MR Diaz S. Quinteros El al. Contracepive eficacy and clinical perormance ofNestorene implants
in postpartum women. Cotracopton 2001.84: 308-378.
“
4
st
McCann MF. Moggia AV. Higgins JE. ota. The eects ofa progetivon ral contraceptive (levonorgestrel
003 mg on breastfeeding, Contraception 1889; 40: 635-648,
Moggia AV, Hanis GS, Ounson TR oa comparative study ofa progester ni ral entaceptive versus.
on hormonal methods in lactating women in Buenos Ares Argentina. Contraception 1901 6: 31-43.
Relnprayoon D,Taneepanichshul S, Eunyavejchevin 5, tal Ets of the elonogestretreleasing
contraceptive implant (mplanan?) on parameters of breasiceing compared those fan intrauterino
(dee. Contraception 2000; 62: 230-246
Schiappacasse V Daz , Zepeda A, a al Heath and growth tintas breast by Nepant contraceptive
implants users: a sicyear felowup dy. Contraception 2002: 66: 57-65.
‘Seth U,Yadava HS, Agarwal N, a al fect of a subdermal st implat containing nereindrone acetato
on human lactation. Contraception 1977, 16: 383-398,
‘Shaaban MM, Contraception with progestogens and progesterone dung lactato J Sterol Biochem Mol lol
1891.40: 705-710,
‘Shaaban MM, Salem HT, Abdulah KA, Infuence ef levonegeste contraceptive implants, NORPLANTO,
inated eufy postpartu upon allen and nan growth, Contraception 1885; 32: 623-636,
‘Shaamash AH, Sayed GH Hussien MM et a A comparative study of the levonorgestel-eleasing intrauterine
system Mirena versus the Copper 13804 ntrauterine device durng lactation: breastfeeding peromance
infant growin and infant development. Contraception 2005, 72: 246-351
‘Shikary ZK, Berabet SS. Todóyunia WS, ta. Pharmaccd mami eects of levonorgestrel (LNG)
Administered ler orally orsubdermal lo eat posipatum lactating mothers on the unnary levels of lil
‘Simulating hamone (FSH), luteinizing hormone (LH) and testosterone (in ther breast-fed male inant,
‘Contraception 1988; 34 403-412
Taneepanichsh S, Reipraycon D, ThahumyanonP, tal tects ofthe etonogestrelreleasing implant
Implanen® and a nonmedcate ineauterne device onthe grou of breastfed infants, Cortraceion 2005
DE
Tankeyocn M, Oustsin N, Chalapal 5, el fects ofhomanal contraceptives on milk volume and infant
growth. WHO Special Programme of Research, Development and Research Trang in Human Reproducton
Task Force on Oral Contacepives. Contraception 1084; 30: 505-522,
Viet OP The acceptablty ofa progestagen-nly contraceptive during breast-feeding. Contraception 1989: 21
563-668.
Zacharias 5, Agulera E,Assenzo JR, a al Eects of hormonal and nonhomonal contraceptives on action
and incidence of pregnancy Contraception 1906, 33: 205-213
veut Beal nd apro Hah sa
4
st
McCann MF. Moggia AV. Higgins JE. ota. The eects ofa progetivon ral contraceptive (levonorgestrel
003 mg on breastfeeding, Contraception 1889; 40: 635-648,
Moggia AV, Hanis GS, Ounson TR oa comparative study ofa progester ni ral entaceptive versus.
on hormonal methods in lactating women in Buenos Ares Argentina. Contraception 1901 6: 31-43.
Relnprayoon D,Taneepanichshul S, Eunyavejchevin 5, tal Ets of the elonogestretreleasing
contraceptive implant (mplanan?) on parameters of breasiceing compared those fan intrauterino
(dee. Contraception 2000; 62: 230-246
Schiappacasse V Daz , Zepeda A, a al Heath and growth tintas breast by Nepant contraceptive
implants users: a sicyear felowup dy. Contraception 2002: 66: 57-65.
‘Seth U,Yadava HS, Agarwal N, a al fect of a subdermal st implat containing nereindrone acetato
on human lactation. Contraception 1977, 16: 383-398,
‘Shaaban MM, Contraception with progestogens and progesterone dung lactato J Sterol Biochem Mol lol
1891.40: 705-710,
‘Shaaban MM, Salem HT, Abdulah KA, Infuence ef levonegeste contraceptive implants, NORPLANTO,
inated eufy postpartu upon allen and nan growth, Contraception 1885; 32: 623-636,
‘Shaamash AH, Sayed GH Hussien MM et a A comparative study of the levonorgestel-eleasing intrauterine
system Mirena versus the Copper 13804 ntrauterine device durng lactation: breastfeeding peromance
infant growin and infant development. Contraception 2005, 72: 246-351
‘Shikary ZK, Berabet SS. Todóyunia WS, ta. Pharmaccd mami eects of levonorgestrel (LNG)
Administered ler orally orsubdermal lo eat posipatum lactating mothers on the unnary levels of lil
‘Simulating hamone (FSH), luteinizing hormone (LH) and testosterone (in ther breast-fed male inant,
‘Contraception 1988; 34 403-412
Taneepanichsh S, Reipraycon D, ThahumyanonP, tal tects ofthe etonogestrelreleasing implant
Implanen® and a nonmedcate ineauterne device onthe grou of breastfed infants, Cortraceion 2005
DE
Tankeyocn M, Oustsin N, Chalapal 5, el fects ofhomanal contraceptives on milk volume and infant
growth. WHO Special Programme of Research, Development and Research Trang in Human Reproducton
Task Force on Oral Contacepives. Contraception 1084; 30: 505-522,
Viet OP The acceptablty ofa progestagen-nly contraceptive during breast-feeding. Contraception 1989: 21
563-668.
Zacharias 5, Agulera E,Assenzo JR, a al Eects of hormonal and nonhomonal contraceptives on action
and incidence of pregnancy Contraception 1906, 33: 205-213
veut Beal nd apro Hah sa
ACTE
s.
ai
En
Zafar J,Agulera E. Munoz-Pinto G. Maintenance of lactation by means of continuous oudose
progestogen sven postpartum as a centracepve. Contraception 1978; 13: 313-318,
Knight J. Pyper C. Postal contraception: what are the choices? Nursing in Practice 2002: May: 23-25
Faculty of Sexual and Reproductive Heathcate Postnatal Sexual and Reproductive Heath 2008, 1:
Ed = sn lasse 8 Feb 2018]
Faculty of Famly Planning and Reproductive Heath Care. Clinical Efeciveness Unit The use of
conracepion utsde the terms one product leence Fam Plam Reprod HealthCare 2005, $4: 25-241,
io Heath Organization Calaberatve Study of Cardiovascular Disease and Sterid Hormone
Coniracetio. Cardiovascular Disease and Use of Oral and njecableProgestogen Orly Contraceptives and
(Combines injectable Contraceptives. Cortracoption 1098, 7: 315-328
‘Dunn N.Faraghe 8, Therogeod M. tal. Oral contracepives and myocardial infarction: esuts ofthe MICA,
case-contol study BM 1999: 318: 1579-1584,
Cot P HannafordP, Risk factors for acute myocardainfrlien in women ~ evidence tem the Royal College
of General Practioners oral contracepive study, 81/1988, 298: 165-168
Rosenberg R, Palmer JR, Shapo , Decne inthe isk ofmyocardal inacción among women who stp
smoking, N Engl J Med 1060, $22. 213-217.
Vessey M Painter, Yeates D. Mortal in elation to ral contraceptive and cigarette smoking. Lancet 2003;
362: 105-101,
McEidu P.Dobsen A, Beaglehole tal Rapid reduction on coronary risk fr those who qui cigarette
smoking, Aust NZJ Pub Heath 1686, 22: 787-791,
enfield SA, Stampfer M, Rosner BA. Smoking and smoking cessation in relation to mortality in women
AMA 2008: 7: 2097-2047,
man 6. Depomedronprogesterone acetate as a contraceptive agents efect on weight and blood
pressure, Am J Obstet Gynecol 1972: 114: 97-102.
Clark MK, ion 5, Sowers, al Weight. at mass, and central distin off increase when women
Use depotmedroxprogesterone acetate or contracepin. It J Obes (Lon) 205; 29: 1252-1258
Kozlouski Kd Roker VI. Hendon À
‘Adolese Heat 1095: 16 73-378.
al Adolescents and Norplant: preliminary dings of side eects. J
s.
ai
En
Zafar J,Agulera E. Munoz-Pinto G. Maintenance of lactation by means of continuous oudose
progestogen sven postpartum as a centracepve. Contraception 1978; 13: 313-318,
Knight J. Pyper C. Postal contraception: what are the choices? Nursing in Practice 2002: May: 23-25
Faculty of Sexual and Reproductive Heathcate Postnatal Sexual and Reproductive Heath 2008, 1:
Ed = sn lasse 8 Feb 2018]
Faculty of Famly Planning and Reproductive Heath Care. Clinical Efeciveness Unit The use of
conracepion utsde the terms one product leence Fam Plam Reprod HealthCare 2005, $4: 25-241,
io Heath Organization Calaberatve Study of Cardiovascular Disease and Sterid Hormone
Coniracetio. Cardiovascular Disease and Use of Oral and njecableProgestogen Orly Contraceptives and
(Combines injectable Contraceptives. Cortracoption 1098, 7: 315-328
‘Dunn N.Faraghe 8, Therogeod M. tal. Oral contracepives and myocardial infarction: esuts ofthe MICA,
case-contol study BM 1999: 318: 1579-1584,
Cot P HannafordP, Risk factors for acute myocardainfrlien in women ~ evidence tem the Royal College
of General Practioners oral contracepive study, 81/1988, 298: 165-168
Rosenberg R, Palmer JR, Shapo , Decne inthe isk ofmyocardal inacción among women who stp
smoking, N Engl J Med 1060, $22. 213-217.
Vessey M Painter, Yeates D. Mortal in elation to ral contraceptive and cigarette smoking. Lancet 2003;
362: 105-101,
McEidu P.Dobsen A, Beaglehole tal Rapid reduction on coronary risk fr those who qui cigarette
smoking, Aust NZJ Pub Heath 1686, 22: 787-791,
enfield SA, Stampfer M, Rosner BA. Smoking and smoking cessation in relation to mortality in women
AMA 2008: 7: 2097-2047,
man 6. Depomedronprogesterone acetate as a contraceptive agents efect on weight and blood
pressure, Am J Obstet Gynecol 1972: 114: 97-102.
Clark MK, ion 5, Sowers, al Weight. at mass, and central distin off increase when women
Use depotmedroxprogesterone acetate or contracepin. It J Obes (Lon) 205; 29: 1252-1258
Kozlouski Kd Roker VI. Hendon À
‘Adolese Heat 1095: 16 73-378.
al Adolescents and Norplant: preliminary dings of side eects. J
ni
7
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a.
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medtonyprogesterane acetate. J Podio Gynecol 2002 15: 70-82.
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260-278.
Viesnof ©, Jan JK, Mél La al Changes in weight wth depot meskonyprogesterone acetate
subeutanecus njecion 104 mg/ml. Contraception 2007: 78: 261-267.
Bonny AE. Ziele J Harvey R, et a Weight gan in obese and nenobese adolescent gtsintiating depot
medronyprogeserene oral corracepve pls er no hormonal contraceptive med. Ach Poda Adolesc
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Associates wih injectable and oral conraceplve use. Am J Obstet Gynec! 2000; 200 320 61-329 63.
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de pines ina case of congentaltyp 2leng OT syndrome Heart Rhythm 2012; 7 1149-1147
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Fev Obstet Gynecol 2010; 3: 55-85,
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5.
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Mombasa, Kenya. J irfect Dis 2008, 87. 350-363
Moscik AB, Sibosk S, Powel K eta Risks for inedent human papllemavrus infection and low-grade
‘squamous irraepthela lesion development in youn females. JAMA 2001: 285 2005-3002
Nsofr I, Bello CS, Ekvempu CC. Sexual transmitted disease among women attending a famiy planing
line in Zaria, Nigeria. tJ Gynecol Obstet 1989; 2: 285-267.
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Urogenital smears fr epidemiological purposes. Eur) Obstel Gynecol Reprod ie 1988; 27: 268-207.
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Diab Kh, Zaki MA. Contraception in dabeie women: comparative metabolic study ofnorlan, depor
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26: 17-28.
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four compounds wih diferent esrogenfprogestogen profes. Fel Son! 686,46. 856-884
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108757 122-128.
[DhaluinV. Vigra Y Peltier 6, tal Natural istry of focal nodular hyperplasia. Arirospechve study of
cases, Castroonterol Cn Bol 2001 25: 1008-1010
Malie O, KobeterH, Maison Pel. Oral contraceptive use and focal nodular hyperplasia ofthe Ive.
“Gasroentéroogy 2000: 18: 560-584,
Kapp N, Curis KM, Hormonal contraceptive use among women with ner tumors: a sytemati review
Contraception 2009; 80 387-200.
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rap in cernive cats Gastroeterlogy 200%; 120: 13-20
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surgery fr Crohn's disease. Dig Dis Sel 1962.37. 1977-1882
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disease, The Canadian Mesalamine for Remission of Crehn's Disease Study Group, Gastoenterdogy 1688;
Fées
Viignt JP. Factors infuencing fr relapse in patients with Crohn's disease. J in Gastrorterl 1062; 15.
126.
Haddad LB, Curtis KM, Lagardy- Wms JK, et al Contraception for individuals wäh sickle cll disease: a
Sysemabe review ofthe iterate. Cotracepton 2012: 85: 827-637.
/Adadevoh BK, Isaacs WA. The elect of megesrol acetate on sicking. Am J Med Soi 1973: 265: 387-370,
Barbosa IC, Lapdpo OA, Mari de Lourdes PN oa Carbohyerate metal in sickle cl paints using
subdermalimplatcontaiing nomegeserlaceate (Unilan. Contracepten 2001.03: 263-265,
de Aooë M, De Castle Z, GuereroF, ea. fects of Depo-Provera® er Mirogynan® on the pain ses
‘fie call anemia patenta. Contraception 1887: 6: 313-316.
De CeulaerK, Hayes R, Gruber C, ef al Medroxyprogesterone acetate andhomezygous sickle-cel disease
Lancet 1082, 2: 229-231
Howard RJ, Ui ©. Tuck SM. Contraceptives, counseling, and pregnancy in women with sickle col disease.
‘BMI 1990: 306: 1735-1737
Ladpo OA Falus AG, Fellum PJ, eta. Norplant use by women wih sche cel disease. nt J Gynecol
‘Obstet 1653: 44 85-07,
Nascimento ML. Laipo OA, Coutinho E Nomegesral acetate contraceptive implant use by women wth
ki cal Anease. Clin Pharmacol Ther 1908, 64: 433-438,
‘Yeeng VIC, Tuck SM, Yardumian A. Red cel deormabity in oral contraceptive pl users with sit cet
anaemia. J Haerito! 199; 104: 68-70,
(Choy E, Ganeshalngam K, Semb AG, ef al Cardiovascular skin rheumatoid atts: recent avances inthe
understanding ofthe pista rl ofinammation risk predictor andthe mpac ftreaiment. Rheumatology
2014 53: 2145-2184
‘Camacho EM, Lunt M, Faragher TM, of al The relationship between cra contraceptive use and funcional
‘outcome in women wih recent onset inflammatory polaris resul from te Nora Ais Register.
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ss.
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ar Scand J Rheumatol 965, 12 09-72.
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Er
Sanchez-Guerrero J, Uribe AG, Jimenez-Santana Lt al À Hal of centraceptve methods in women wih
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angers P, Dougados A, Passer C, et a. Infuence of ra contraceptive therapy onthe ati of systeme
lupus eynematosus Arts Rheum 1082.25 618-623,
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lupus eyinemalosus, Rheumatology 2004. 48 1306-1380
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patients wth antiphospholipid anbodes. Rheumatology 2002: 29: 1683-1688.
sale JM Abrahamowice M.Grodzicy . ot al rational Framingham risk actors flo fly account for
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yah Fac o Sex! and apr done Huan cy
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Demers R, Blais JA, PretyH.Rheumatoi arts tested by northymodrel associated wth mestrano!
Fica aspect and laboratory ests In French]. Can Med Assoc J 1866, 96: 380-254
Drossaers-Babker KW, Zuinderman AH, Van 2D, e al Pregnancy and ra contraceptive use do nt
‘ignifiantlyinuence outcome in ong term eumatoi artis. Am Rheum Os 2002; 64: 405-408.
(bert M, Resten J, Cunningham C, e al Norlhynodre with mestranal in treatment of heumated arts.
‘na 1964: 190-236,
Gil D. Rheumatic complains of women using ant-ovlstery drugs. An evaluation. Chronic Dis 1968; 24:
ss.
Hazes NA, Dikmane BA, Vandenbroucke JP. ta. Oral contraceptive retmen fo rheumatid artis: an
‘open study in 10 female patents. Br J Rheumatl 1889, AUS 1) 28-20,
Ostensen M.Aune 8. Husby G. Ete of pregnancy and hormonal changes on the acy o rheumatoid
ar Scand J Rheumatol 965, 12 09-72.
Vignes PA, Dornan RI Efecto large doses of progesterone in rheumatldathris. Am J Med Se 1051; 222:
Er
Sanchez-Guerrero J, Uribe AG, Jimenez-Santana Lt al À Hal of centraceptve methods in women wih
systemic lupus eryhematosus. NEngIJ Med 2005. 363: 2530-2642
angers P, Dougados A, Passer C, et a. Infuence of ra contraceptive therapy onthe ati of systeme
lupus eynematosus Arts Rheum 1082.25 618-623,
Mintz 6, Guerez G, DelezeM, el. Contraception wih progestogensinsystemicupus exytematosus.
Corracepion 1964; 30: 29-28,
‘Sematsy S, Ramsey-Goldman R, Gordon C, ot Factors associated wäh abnormal Pap resus in systeme
lupus eyinemalosus, Rheumatology 2004. 48 1306-1380
Bematsky , Clarke A, Ramsey-Geldman R, t al Hormona exposures and brest cancer ina sample of
‘women wih sytemi lupus erythematosus. Rheumatology 2004; 43: 178-1181.
(Chopra, Koren 5. Greer ML, etal. Factor Y Leiden, po-ombin gene mutation, and hrembasi skin
patients wth antiphospholipid anbodes. Rheumatology 2002: 29: 1683-1688.
sale JM Abrahamowice M.Grodzicy . ot al rational Framingham risk actors flo fly account for
accelerated atherosclerosis in systemic lupus erythematosus. Ar Rheum 2001.44: 2331-2337.
yah Fac o Sex! and apr done Huan cy
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Petr. Musculoskeletal complications of systemic lupus enthemstosusin the Hopkins Lupus Cor: an
update Ais Care Res 1985, 8: 137-148.
Peu. Km MY, Kalunan KC, et al. Combined oral conracepives in women wh system lupus
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Pet Lupus n Batimore: evidence based ‘clinical peas rom the Hopkins Lupus Cohar. Lupus 2005, 4
970-873.
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SÍSLE, Scand J Rheumatol 1991 20: 427-433,
ulunen HA, KaajaR Fman C.Contracepive practice in wemen with systemic lupus erythematosus. Br
Rheumala 1993, 32: 227-230,
Manz, Melahn EN, Raie JE, ell Age-speci incidence rates of myocardial infrcion and angina in
women wih system lupus erythematosus: comparison withthe Framingham Study, Am J Epideml 1997;
‘as 408-418
MeAindonT, Giannakt L,Tau tal. Envronmental factors predicting nephri in systemic pus
ythemalosus. Ann Rhoum Dis 1993, 52 720-728.
MeDona J Stewart J. Urowtz MB, al Peripheral vascular disease in patents wih systemic pus
‘erythematosus. Ann Rheum Dis 1962; 5158-60,
Petr. Musculoskeletal complications of systemic lupus enthemstosusin the Hopkins Lupus Cor: an
update Ais Care Res 1985, 8: 137-148.
Peu. Km MY, Kalunan KC, et al. Combined oral conracepives in women wh system lupus
enfhemalosus. N Eng Med 2005; 363: 2550-2888,
Pet Lupus n Batimore: evidence based ‘clinical peas rom the Hopkins Lupus Cohar. Lupus 2005, 4
970-873.
‘Sanches-Guerero J, Uribe AG, Jmenes-Santana Lt al À sl of contraceptive methods in women with
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‘systemic lupus ernematosus. Ahi eum 2005, 58 608-612.
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management of menerhaga in women with hemastat disorder. Am J Obstet Gynecol 2008; 193. 1361-
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Marin CW, Broun AH, Baird OT. A pl study ofthe efecto methovexate or combined ra contacepive
on bleeding patems ater induction of abortion vih mifepristone and a proslagandın pessary Contraceaion
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1900, 14: 722-725
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Gilum LA, Mamidipud SK, Johnston SC. Ischaemic stroke risk wi ral contacepives: a meta-analysis
JAMA 2060; 204: 72-78
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sa.
hades YS, Rice J Joh La al Ora contraceptive use aná the risk of myocardial nfarcton: a meta ana
Contraception 200%: 68 1-17.
Lawson DH, Davidson JF, ek. Oral contraceptive use and vencustramboembolsm: absence an ect
of smoking. BH 1677: 2 729-730.
gan D, Esti 8, Kreiner S. Oral contraceptives and venus Iwomboembols. A case-contr study
Contraception 1908; 57: 291-201
Nightingale AL, Lawrenson RA. Simpson EL ta. The effects of age. body mass index, smoking and general
heath onthe risk of venous tromboembolism In users of combined eral eetracepves. Eur J Contracept
oprod Heath Care 2000, 5: 285-274
yah Fac o See and apr done Heaths wr
".
s.
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2
Lähteenmaïi P. Rai V.Luukklnen T, tal Cosguiatic factors in women using oral contraceptives or
Intrauterine contaceptve devices immediately ater abrion, Am J Obstet Gynecol 1881. 141: 175-178.
Marin CW, Broun AH, Baird OT. A pl study ofthe efecto methovexate or combined ra contacepive
on bleeding patems ater induction of abortion vih mifepristone and a proslagandın pessary Contraceaion
‘eee: Se: 22-108
Niswonger MH, London, GO, Anderson GV, tal Oral contraceptives during immediate posabera arca
(Obstet Gynecol 1068,32. 328-327.
Peterson WF. Contraceptive therapy folowing therapeutic aborion. Obstet Gynacol 1974; 44: 853-887.
Tang OS, Gao PP, Cheng La. Arandomized double ind placebo-controled study o assess the effect of
oral cortraceptve ps cn th culcome ofmedical aborion with mifepristone and misoprostal, Hum Reprod
1900, 14: 722-725
Tang OS, Xu J, Cheng L ea. The eect of contraceptive pts on he measured blood los in medical
termination of pregnancy by mifepristone and misoposa: a randomized placebo contrae al. Hu
Reprod 2002.17. 99-102
Gael ME, Kapp N, Raw A, Use of combined eal contraceptives pos abotien. Contraception 2009, 80:
Se.
Fine PM, Tryggetad J. Meyers No al Safety and acceptably wäh ie use of a contraceptive vaginal ing
“ter surgical ormedis!asorton. Contraception 2007: 75 367-371
Gilum LA, Mamidipud SK, Johnston SC. Ischaemic stroke risk wi ral contacepives: a meta-analysis
JAMA 2060; 204: 72-78
Lick SS, Walker AM, Sergachis A, tal Oral contraceptives and breast cancer, Br J Cancer 1888: 58.618
sa.
hades YS, Rice J Joh La al Ora contraceptive use aná the risk of myocardial nfarcton: a meta ana
Contraception 200%: 68 1-17.
Lawson DH, Davidson JF, ek. Oral contraceptive use and vencustramboembolsm: absence an ect
of smoking. BH 1677: 2 729-730.
gan D, Esti 8, Kreiner S. Oral contraceptives and venus Iwomboembols. A case-contr study
Contraception 1908; 57: 291-201
Nightingale AL, Lawrenson RA. Simpson EL ta. The effects of age. body mass index, smoking and general
heath onthe risk of venous tromboembolism In users of combined eral eetracepves. Eur J Contracept
oprod Heath Care 2000, 5: 285-274
yah Fac o See and apr done Heaths wr
ACTE
a
a
2
Petts, Winged J, Polen Fe a Risk of vascular disease in women. Smoking oral contraceptives,
roneontraceptve estrogens, and einer factor, JAMA 1978, 282 1150-1154,
Rosenberg L, Palmer JR. Rao RS, et al Low-dose eral contraceptive use andthe sk of myocardial infarction
‘Arch ite Med 2001, 164: 1085-1070.
‘StranevaP HinderterA, Wels E, el al Smoking, oral contraceptives, and cardiovascular reactvy to sess.
(Obstet Gynecol 2000; 98: 78-83
anis 80, van den Bosch MA, Kemmeren JM, ta. Oral contraceptives andthe sk ol myocardial infarction.
IN Eng Med 2001; 348: 1787-4790,
van den Bosch MA, Kemmeren M. Tanis BG, al, The RATIO study oral conraceptves and he ik of
Perpheral arterial isease in young women. Thromb Haemost 2008 1: 436-444.
Paule NR, Chang CL, Frey Ya a Venous hromboemboto disease and combined oral contacegtves:
resuls oiniematicnal multicentre case control study, ici Heath Organization Calabertve Study of
Cartovascula Disease and Steroid Home Convacepton Lance! 1605 46: 1875-1582.
ME P, Dobson A, Beaglehole R, tal Raid reduction on coronary risk for those who qui cigarette
‘smoking, Aust NZ J Buble Heath 1668, 22: 787-791
Rosenberg R, Palmer JR, Shape 5. Decne inthe isk of myocardial infarction among women who stop
smoking, N Engl J Med 1960, 822. 213-217
enfield SA, Stampfer Mu, Rosner BA. Smoking and smoking cessation in relation to mortality in women,
{MA 2008: 7. 2097-2047.
/AbdotahiM, Cushman M, Rosendaal FR. Obesty risk of venous Ihrambesis and the interaction with
‘coagulation factor levels and ral contraceptive use. Thromb Haemost 2003.89: 483-488,
gan D, Esti 8, Kreiner S. Oral contraceptives and venous Iwomboembolm; a fue year national
case-contol tidy. Contraception 2002 65. 187-198,
Pomp ER, le Cease S, Rosendaal FR, e al Rak of venous trombosis: obesity and it joint effect wth ral
conracepive use and prebrombetie mutations. Br Heemato! 2007, 139 2-286.
‘Sidney S, Petit DB, Sof GA, e al Venous thromboembalc disease in users o low-estogen combined
esrogen-progesin ral conracepives. Cortraceplon 2004: 70: 3-10.
Schwartz SM, Petit DB, Siscovik DS, e al Soke and use fleur dose ral contraceptives in young women
apodied analysis fe US studs. Stroke 1968; 29: 2277-2284.
a
a
2
Petts, Winged J, Polen Fe a Risk of vascular disease in women. Smoking oral contraceptives,
roneontraceptve estrogens, and einer factor, JAMA 1978, 282 1150-1154,
Rosenberg L, Palmer JR. Rao RS, et al Low-dose eral contraceptive use andthe sk of myocardial infarction
‘Arch ite Med 2001, 164: 1085-1070.
‘StranevaP HinderterA, Wels E, el al Smoking, oral contraceptives, and cardiovascular reactvy to sess.
(Obstet Gynecol 2000; 98: 78-83
anis 80, van den Bosch MA, Kemmeren JM, ta. Oral contraceptives andthe sk ol myocardial infarction.
IN Eng Med 2001; 348: 1787-4790,
van den Bosch MA, Kemmeren M. Tanis BG, al, The RATIO study oral conraceptves and he ik of
Perpheral arterial isease in young women. Thromb Haemost 2008 1: 436-444.
Paule NR, Chang CL, Frey Ya a Venous hromboemboto disease and combined oral contacegtves:
resuls oiniematicnal multicentre case control study, ici Heath Organization Calabertve Study of
Cartovascula Disease and Steroid Home Convacepton Lance! 1605 46: 1875-1582.
ME P, Dobson A, Beaglehole R, tal Raid reduction on coronary risk for those who qui cigarette
‘smoking, Aust NZ J Buble Heath 1668, 22: 787-791
Rosenberg R, Palmer JR, Shape 5. Decne inthe isk of myocardial infarction among women who stop
smoking, N Engl J Med 1960, 822. 213-217
enfield SA, Stampfer Mu, Rosner BA. Smoking and smoking cessation in relation to mortality in women,
{MA 2008: 7. 2097-2047.
/AbdotahiM, Cushman M, Rosendaal FR. Obesty risk of venous Ihrambesis and the interaction with
‘coagulation factor levels and ral contraceptive use. Thromb Haemost 2003.89: 483-488,
gan D, Esti 8, Kreiner S. Oral contraceptives and venous Iwomboembolm; a fue year national
case-contol tidy. Contraception 2002 65. 187-198,
Pomp ER, le Cease S, Rosendaal FR, e al Rak of venous trombosis: obesity and it joint effect wth ral
conracepive use and prebrombetie mutations. Br Heemato! 2007, 139 2-286.
‘Sidney S, Petit DB, Sof GA, e al Venous thromboembalc disease in users o low-estogen combined
esrogen-progesin ral conracepives. Cortraceplon 2004: 70: 3-10.
Schwartz SM, Petit DB, Siscovik DS, e al Soke and use fleur dose ral contraceptives in young women
apodied analysis fe US studs. Stroke 1968; 29: 2277-2284.
#.
si
5.
‘Sidney S, Siscoick DS, Pest DB. et al Myocardial infarction and use oflow-dose oral contraceptives:
pooled analysis of 2US suis, Circulation 1968; 98 1058-1083.
Hot VL Cushing Haugen KL Daing JR, Body weight and sk of oral contraceptive aie. Obstet Gynecol
202. $9: 620-827.
Weiss HO, Nehoda H,Labeck , e af Pregnancies ater adjustable gastric banding, Obos Surg 2001; 44
Wiss ne eg adjustable e ing. Obes Sug
Gants EG, Ceulemans R van HR e al Contraceptive treatment ater bilepancreate diversion needs
ren Obes Surg 2008 15. 376-282 ke
Victor A, Odin V Kal JS. Ora contraceptive absegtion and sex hormone binding globulnsin obese
Women’ Sted of jeunateal bypass Gore Cir Non Am 1607-16
Andersen AN, Lebech PE, Sorensen TI, Sex hormone levels and itestnal absorption of estradiol and
norgesrelin women folowing bypass surgery fr morbid chest In J Obes 1982, 6: 81-86.
ira, Bobrosuaa Jai Zeiss Z tl Oral and ransdemalhomanal contacto women
EE sah EE EEE us
za 8 Karine, Wage M, el Combined oral rasen in women afer eal translation
‘ure Endesnol Lot 2008 27 ers,
ably Zinioviee 2, obrowska K Kamips Bot a Low-dose harmenal contraception ater er
PRO Trap Ps S007 39 SO ISS “en
Federkow OM, Cotenblum 8, Shafer EA. Chelestass induced by oestrogen ater ver transplantation. BMJ
1989, 299: 1080-1081
anal Inte for Heath and Care Excatence (NICE) Hypertension in Ads: Diagnosis and Management.
zn. 2 area 127 [acessed 8 Feb 2018]
Heinemann LA, Lewis MA, Spitzer WO, etal Thremboembole stroke in young women À European case-
control study on eal cntracepives, Cortracegtin 1996, 57. 20-37.
Levis MA, Meinman LAU Spitzer WO, ot al The use of ral contraceptives and the occurrence of acute,
‘myocardial intro in young women, Rest rom te Transnational Study on Oral Contracepives and he
Hea of Yung Women. Cortracepton 1997.56. 129-140.
Peulter NR, Chang CL, Farley TM, el al Haemesthage stroke, veal stroke rik, and combined oral
contraceptives: esuls ofan nemabonal multcente,easecantel study It J Gynecal bet 1667 : 103
Poulter NR, Chang CL. Frey TM, e al Ischaemic stroke and combined ora contraceptives: ests of an
Intemational mulicentr case corte study. WHO Callaberatve Study of Cardiovascular Disease and Sterid
Hormone Contraception. Lancet 1006, 348 498-505.
si
5.
‘Sidney S, Siscoick DS, Pest DB. et al Myocardial infarction and use oflow-dose oral contraceptives:
pooled analysis of 2US suis, Circulation 1968; 98 1058-1083.
Hot VL Cushing Haugen KL Daing JR, Body weight and sk of oral contraceptive aie. Obstet Gynecol
202. $9: 620-827.
Weiss HO, Nehoda H,Labeck , e af Pregnancies ater adjustable gastric banding, Obos Surg 2001; 44
Wiss ne eg adjustable e ing. Obes Sug
Gants EG, Ceulemans R van HR e al Contraceptive treatment ater bilepancreate diversion needs
ren Obes Surg 2008 15. 376-282 ke
Victor A, Odin V Kal JS. Ora contraceptive absegtion and sex hormone binding globulnsin obese
Women’ Sted of jeunateal bypass Gore Cir Non Am 1607-16
Andersen AN, Lebech PE, Sorensen TI, Sex hormone levels and itestnal absorption of estradiol and
norgesrelin women folowing bypass surgery fr morbid chest In J Obes 1982, 6: 81-86.
ira, Bobrosuaa Jai Zeiss Z tl Oral and ransdemalhomanal contacto women
EE sah EE EEE us
za 8 Karine, Wage M, el Combined oral rasen in women afer eal translation
‘ure Endesnol Lot 2008 27 ers,
ably Zinioviee 2, obrowska K Kamips Bot a Low-dose harmenal contraception ater er
PRO Trap Ps S007 39 SO ISS “en
Federkow OM, Cotenblum 8, Shafer EA. Chelestass induced by oestrogen ater ver transplantation. BMJ
1989, 299: 1080-1081
anal Inte for Heath and Care Excatence (NICE) Hypertension in Ads: Diagnosis and Management.
zn. 2 area 127 [acessed 8 Feb 2018]
Heinemann LA, Lewis MA, Spitzer WO, etal Thremboembole stroke in young women À European case-
control study on eal cntracepives, Cortracegtin 1996, 57. 20-37.
Levis MA, Meinman LAU Spitzer WO, ot al The use of ral contraceptives and the occurrence of acute,
‘myocardial intro in young women, Rest rom te Transnational Study on Oral Contracepives and he
Hea of Yung Women. Cortracepton 1997.56. 129-140.
Peulter NR, Chang CL, Farley TM, el al Haemesthage stroke, veal stroke rik, and combined oral
contraceptives: esuls ofan nemabonal multcente,easecantel study It J Gynecal bet 1667 : 103
Poulter NR, Chang CL. Frey TM, e al Ischaemic stroke and combined ora contraceptives: ests of an
Intemational mulicentr case corte study. WHO Callaberatve Study of Cardiovascular Disease and Sterid
Hormone Contraception. Lancet 1006, 348 498-505.
ACTE
es
m
Poulter NR, Chang CL. Farley TM, e al Acute myocardial infarction and combined oral contraceptives: resus
‘ofan intematonal mulicentre case-cotrol study Lancet 199.349. 1202-1208,
Task Force ofthe American Media Associaton. ra contraceptives and token young waren,
Associated rik ators. JAMA 1075; 234: 718-722.
(rot P, Hannafrd P. Rsk factors fer acute myocardial infarction in women: evidence tom Ihe Royal
College of General Pracicners Oral Contraception Study. BJ 1989, 208: 165-168,
D'Avanzo B La Vecchia C, Neg E. et al Oral contraceptive use andr of myocardial infarction: an lan
esse control tidy. J Epidemiol Communty Heath 1004 4. 324-320
‘Dunn NR, Faragher 8, Thorogood M. ta Risk of myocardial infarction in young female smckers. Heart
1909; 02 581-585.
Hannaford, Cro, Kay CR. Oral contraception and stroke’ evidence fam the Royal Collegeof General
Practioners Oral Contraception Sty. Stroke 1994: 28 935-042.
Kemmeren IM, Tals BC, van den Bosch MA, ea Risk of Arial Thvombosis in Relation to Oral
Contraceptives (RATIO) study oral contracepives and he ik of ischaemic stoke, Stoke 2002 33: 1202-
12e.
Lidegaad O. Oral contraception and risk oa cerebral thromboembolic attack: resul of à case-convol
Sy BMI 1003 306. 056-063,
Lidegaaré 9. Oral contraceptives. pregnancy andthe ik of cerebral thromboombalsm: the nfuence of
abetes hypertension, migraine and previcustrombatic disease. BJOG 1995, 102: 153-159,
Lubianca JN, Faccin CS, Fuchs FD. Oral contraceptives: risk factor for uncotrlld blood pressure among
hypertensive women, Contraception 2008: 6. 19-24
NatkiewceK, Grabieo GR, dae D, ofa Ambulatory blood pressure in mid hypetensive women taking
(rl conracepves, À cae-cantrl study Am J Ayperons 1095, 8. 249-283.
tito, Tis AG, MeNel J, aa Risk schaemicaroke among users o tn cal contraceptive pil The
Melboume Risk Fator Study (MERFS) Group. Stoke 2003; 3: 1975-1880.
Lublanca JN, Moria LB, Gus M, e al Stopping cal cotracepives: an effective blood pressure owen.
intevenoninwwomen wih hypertension. J Hum Hypertens 2005, 19: 451-456,
‘AbergH, Kasson L MelanderS. Studies on toxaemia of pregnancy wäh special reference to blood
pressure. I: Results ater 6-11 years folow up. Ups Med Se! 1978, 83: 97-102.
es
m
Poulter NR, Chang CL. Farley TM, e al Acute myocardial infarction and combined oral contraceptives: resus
‘ofan intematonal mulicentre case-cotrol study Lancet 199.349. 1202-1208,
Task Force ofthe American Media Associaton. ra contraceptives and token young waren,
Associated rik ators. JAMA 1075; 234: 718-722.
(rot P, Hannafrd P. Rsk factors fer acute myocardial infarction in women: evidence tom Ihe Royal
College of General Pracicners Oral Contraception Study. BJ 1989, 208: 165-168,
D'Avanzo B La Vecchia C, Neg E. et al Oral contraceptive use andr of myocardial infarction: an lan
esse control tidy. J Epidemiol Communty Heath 1004 4. 324-320
‘Dunn NR, Faragher 8, Thorogood M. ta Risk of myocardial infarction in young female smckers. Heart
1909; 02 581-585.
Hannaford, Cro, Kay CR. Oral contraception and stroke’ evidence fam the Royal Collegeof General
Practioners Oral Contraception Sty. Stroke 1994: 28 935-042.
Kemmeren IM, Tals BC, van den Bosch MA, ea Risk of Arial Thvombosis in Relation to Oral
Contraceptives (RATIO) study oral contracepives and he ik of ischaemic stoke, Stoke 2002 33: 1202-
12e.
Lidegaad O. Oral contraception and risk oa cerebral thromboembolic attack: resul of à case-convol
Sy BMI 1003 306. 056-063,
Lidegaaré 9. Oral contraceptives. pregnancy andthe ik of cerebral thromboombalsm: the nfuence of
abetes hypertension, migraine and previcustrombatic disease. BJOG 1995, 102: 153-159,
Lubianca JN, Faccin CS, Fuchs FD. Oral contraceptives: risk factor for uncotrlld blood pressure among
hypertensive women, Contraception 2008: 6. 19-24
NatkiewceK, Grabieo GR, dae D, ofa Ambulatory blood pressure in mid hypetensive women taking
(rl conracepves, À cae-cantrl study Am J Ayperons 1095, 8. 249-283.
tito, Tis AG, MeNel J, aa Risk schaemicaroke among users o tn cal contraceptive pil The
Melboume Risk Fator Study (MERFS) Group. Stoke 2003; 3: 1975-1880.
Lublanca JN, Moria LB, Gus M, e al Stopping cal cotracepives: an effective blood pressure owen.
intevenoninwwomen wih hypertension. J Hum Hypertens 2005, 19: 451-456,
‘AbergH, Kasson L MelanderS. Studies on toxaemia of pregnancy wäh special reference to blood
pressure. I: Results ater 6-11 years folow up. Ups Med Se! 1978, 83: 97-102.
7.
7.
7.
n.
Carmichael SM, Taylor MM, Ayers OR. Oral contraceptives, hypertension and toxemia, Obstet Gynecol
1970, 38: 371-376,
Meinl, the R, Laschink M,Etetofhomenal contaceptvs on bed pressure fling pregnancy
induced hypertension In German] ZertralolGynahol 1887, 109, 527-831.
Pritchard JA, Prichard SA Blood pressure response to esrogen progesn oral contraceptive aer
pregnancy induced hypertension Am J Obstet Gynecol 1977, 128: 735-739,
‘iba BM, Tai MM, EbNazer, e al Maternal perinatal outcome associated with he syndrome of
hemalsis, elevated Iver enzymes, andlow platelets in severe preeciampsia-clampsia, Obst! Gynecol
1886: 155: 501-509.
‘Sibi BM, Ramadan MK, Chi RS, e al. Pregnancies complicated by HELLP syndrome (hemalyis,
eva iver enzymes, and low platelets): subsequent pregnancy outcome and longterm prognosis. Am J
‘Obst! Gyraco! 1905, 172 125-128,
rich National Fomulary (rn). 7.3.1. Combined hormonal contraceptives
a [ncoessed 8 Feb 2018)
Royal Cotege of General Practoners. Oral contraceptives, venous trombosis, and varicose veins. / Roy
(Col Gen Pract 1978; 28: 392-268,
Roach RE, Lfering WM van Hyckama lg A, ot al The isk of venous thrombosis inindviduas with a
history of suport vein trombosis and acquired venous hrembate risk factors. Blood 2013, 122 4264
428.
Vi O, Robertson L. Twaddle S, a al Screening fr hrambophia In highs stuaons:a meta-analysis
and cosvefectveness analyse. Br J Haematol 2005 131: 80-90.
Mádtedrop S, van Hylckama Vieg A. Does thombepia testing help nthe cnica management of
patients? Br. Haemoto! 2008, 143: 321-398.
Bleksten D,Bletsein | Oral contraception andttvombophila. Cur Opin Obstet Gynecol 2007: 19: 70-
E
Anderson BS, Olsen J, Nielsen GL. et al Third generation oral corracepives and hertablethrombepila as
‘ak factors of nonfatal venous thrmboembolim. Thromb Haemost 108: 79: 20-31
‘Aznar J. Mira Y. Vaya A ol. Factor V Leiden and prothrembin 6202104 mutationsin young adults wih
SyplogeneIschaeme dicke. Thromb Haomost 2004 81: 1031-103.
7.
7.
n.
Carmichael SM, Taylor MM, Ayers OR. Oral contraceptives, hypertension and toxemia, Obstet Gynecol
1970, 38: 371-376,
Meinl, the R, Laschink M,Etetofhomenal contaceptvs on bed pressure fling pregnancy
induced hypertension In German] ZertralolGynahol 1887, 109, 527-831.
Pritchard JA, Prichard SA Blood pressure response to esrogen progesn oral contraceptive aer
pregnancy induced hypertension Am J Obstet Gynecol 1977, 128: 735-739,
‘iba BM, Tai MM, EbNazer, e al Maternal perinatal outcome associated with he syndrome of
hemalsis, elevated Iver enzymes, andlow platelets in severe preeciampsia-clampsia, Obst! Gynecol
1886: 155: 501-509.
‘Sibi BM, Ramadan MK, Chi RS, e al. Pregnancies complicated by HELLP syndrome (hemalyis,
eva iver enzymes, and low platelets): subsequent pregnancy outcome and longterm prognosis. Am J
‘Obst! Gyraco! 1905, 172 125-128,
rich National Fomulary (rn). 7.3.1. Combined hormonal contraceptives
a [ncoessed 8 Feb 2018)
Royal Cotege of General Practoners. Oral contraceptives, venous trombosis, and varicose veins. / Roy
(Col Gen Pract 1978; 28: 392-268,
Roach RE, Lfering WM van Hyckama lg A, ot al The isk of venous thrombosis inindviduas with a
history of suport vein trombosis and acquired venous hrembate risk factors. Blood 2013, 122 4264
428.
Vi O, Robertson L. Twaddle S, a al Screening fr hrambophia In highs stuaons:a meta-analysis
and cosvefectveness analyse. Br J Haematol 2005 131: 80-90.
Mádtedrop S, van Hylckama Vieg A. Does thombepia testing help nthe cnica management of
patients? Br. Haemoto! 2008, 143: 321-398.
Bleksten D,Bletsein | Oral contraception andttvombophila. Cur Opin Obstet Gynecol 2007: 19: 70-
E
Anderson BS, Olsen J, Nielsen GL. et al Third generation oral corracepives and hertablethrombepila as
‘ak factors of nonfatal venous thrmboembolim. Thromb Haemost 108: 79: 20-31
‘Aznar J. Mira Y. Vaya A ol. Factor V Leiden and prothrembin 6202104 mutationsin young adults wih
SyplogeneIschaeme dicke. Thromb Haomost 2004 81: 1031-103.
ACTE
as
wa
Bennet Odeberg H Resistance to athated protein C highly prevalent among users of ra
conracepives wh venous tramboembahen.JInern Mod 1990, 24: 27-32
Bloemenkamp KW, Rosendaal FR, Hemerhorá FM, ea. Enhancement by factor V Leiden mutation of
Vik deep ven hromboss associated wth oral contraceptives containing ahre-genertin progestagen
[Cemment] Lance 1995 346. 1593-1506,
Bloemenkamp KW, Rosendaal FR, Hemerhors FM, a l Higher sk of venous trombosis during erly
Use of ral contaceptvs in women wih lnherted cting defects. [Comment]. Arch tern Med 2000, 160:
=
(de Brain SF. Stam J, Koopman MM, ot al, Case onrl study ori of cerebral su thrombosis in oral
Conracapive users and in earecon of ho re] carers ofheredtar potvembaticcondtons. The
Cerebral Vencus Sus Thrombosis Study Group. BMJ 1898: 316: 589-592.
Emmerich J, Rosendaal FR, Cattaneo M, tal Combined effect factor V Leiden and prarembin 202108
‘onthe isk of venous tromboembalm = posed analysis 018 case-conr studies including 2310 cases and
3204 controla Study Grup for Pools Analysis n Venous Thromboemboitm. Thromb Haemost 2001; 86
Bo.
Gadeina T, Andre ©, Juca AA, e al Prtwembin 202104 and ral contraceptive use ak factors fr
‘cerebral venaustrombos', Cerebrovase Dis 2005; 1: 49-62.
LagnaniC, PlareiG, Guazzsoca G tal Venous themboemboliem in young women: ol of thrbophile
mulaiens and eal conracepive use Eur Hear 2002.23: 984-090,
Marine, Sacei E, Landi G, eta High rik of cerebravein trombosis in carers of pretrembir-gene
Imation and in users o oral contraceptives. [Comment] N Enpl Med 1998, 338: 1783-1797,
“Marni Tac E, Bucirli Pe Interaction between he 6202104 mutation ofthe protrembin gene
and eal conracepive use in deep ven tombous.Atonasaer Thromb Vase 8011000. 19. 700-703
Marine, BattaglotT, Bei Poa Rik factor and reeurence ate o primary deep vein trembosis
oftheupper extremes, Ceulaton 2008; 110 856-370
Marine, Bttagla ©. Burgo, et al Oral contraceptive use, hrombophila and ther interaction in young
"women wih ichaemie stoke, Heematologca 2008, D 844.847
Madeldorp S. Meinad JR, Koopman MM, el A prospective study of asymptomatic cars ofthe factor V
Leiden mutation o determine the incidence of venous Inromhoembeiem. (Comment An ner Med 200
‘5322-097,
Pabinger |, Schneider B. Thrombotic ik of women with heredar antihrombin I ren C- and pre
‘Scdetzsency talon eral contracepive meciaton, The GTH Study Group on Natura Innbtors.Throm>
Haemost 1994; 71 546-552
as
wa
Bennet Odeberg H Resistance to athated protein C highly prevalent among users of ra
conracepives wh venous tramboembahen.JInern Mod 1990, 24: 27-32
Bloemenkamp KW, Rosendaal FR, Hemerhorá FM, ea. Enhancement by factor V Leiden mutation of
Vik deep ven hromboss associated wth oral contraceptives containing ahre-genertin progestagen
[Cemment] Lance 1995 346. 1593-1506,
Bloemenkamp KW, Rosendaal FR, Hemerhors FM, a l Higher sk of venous trombosis during erly
Use of ral contaceptvs in women wih lnherted cting defects. [Comment]. Arch tern Med 2000, 160:
=
(de Brain SF. Stam J, Koopman MM, ot al, Case onrl study ori of cerebral su thrombosis in oral
Conracapive users and in earecon of ho re] carers ofheredtar potvembaticcondtons. The
Cerebral Vencus Sus Thrombosis Study Group. BMJ 1898: 316: 589-592.
Emmerich J, Rosendaal FR, Cattaneo M, tal Combined effect factor V Leiden and prarembin 202108
‘onthe isk of venous tromboembalm = posed analysis 018 case-conr studies including 2310 cases and
3204 controla Study Grup for Pools Analysis n Venous Thromboemboitm. Thromb Haemost 2001; 86
Bo.
Gadeina T, Andre ©, Juca AA, e al Prtwembin 202104 and ral contraceptive use ak factors fr
‘cerebral venaustrombos', Cerebrovase Dis 2005; 1: 49-62.
LagnaniC, PlareiG, Guazzsoca G tal Venous themboemboliem in young women: ol of thrbophile
mulaiens and eal conracepive use Eur Hear 2002.23: 984-090,
Marine, Sacei E, Landi G, eta High rik of cerebravein trombosis in carers of pretrembir-gene
Imation and in users o oral contraceptives. [Comment] N Enpl Med 1998, 338: 1783-1797,
“Marni Tac E, Bucirli Pe Interaction between he 6202104 mutation ofthe protrembin gene
and eal conracepive use in deep ven tombous.Atonasaer Thromb Vase 8011000. 19. 700-703
Marine, BattaglotT, Bei Poa Rik factor and reeurence ate o primary deep vein trembosis
oftheupper extremes, Ceulaton 2008; 110 856-370
Marine, Bttagla ©. Burgo, et al Oral contraceptive use, hrombophila and ther interaction in young
"women wih ichaemie stoke, Heematologca 2008, D 844.847
Madeldorp S. Meinad JR, Koopman MM, el A prospective study of asymptomatic cars ofthe factor V
Leiden mutation o determine the incidence of venous Inromhoembeiem. (Comment An ner Med 200
‘5322-097,
Pabinger |, Schneider B. Thrombotic ik of women with heredar antihrombin I ren C- and pre
‘Scdetzsency talon eral contracepive meciaton, The GTH Study Group on Natura Innbtors.Throm>
Haemost 1994; 71 546-552
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