Contraindications and precautions for combined hormonal contraception
Contraindications to combined hormonal contraception are largely related to the increased risk of venous thromboembolism (VTE) and cardiovascular disease, associated with estrogen use.
Combined hormonal contraception is contraindicated (UKMEC 4) in:
- current breast cancer
- the first 6 weeks postpartum if breastfeeding (but safe to use after this timeframe)
- the first 3 weeks postpartum in individuals with additional risk factors for VTE
- migraine with aura within the last 5 years
- current or past history of ischaemic heart disease, stroke or transient ischaemic attack
- aged 35 years or older and smoking either 15 or more cigarettes per day (or any amount of nicotine vaping according to Australian consensus guidelines)
- hypertension (systolic blood pressure 160 mmHg or higher, diastolic blood pressure 100 mmHg or higher)
- complicated valvular or congenital heart disease
- current or past history of VTE
- positive antiphospholipid antibodies
- known thrombogenic mutation
- major surgery with prolonged immobilisation
- severe (decompensated) cirrhosis
- hepatocellular adenoma or malignant liver tumour.
Combined hormonal contraception requires expert clinical judgment or referral (UKMEC 3) in certain circumstances, including:
- body mass index (BMI) more than 35 kg/m2
- diabetes with nephropathy, retinopathy, neuropathy or other vascular disease
- history of migraine with aura, but no episodes within the last 5 years
- multiple risk factors for cardiovascular disease
- gall bladder disease (medically treated or current)
- a first-degree relative with a VTE (provoked or unprovoked) under the age of 45 years
- between 0 to 3 weeks postpartum and do not have additional VTE risk factors (and are not breastfeeding)1
- between 3 to 6 weeks postpartum, and do have additional VTE risk factors (and are not breastfeeding2).
See the Faculty of Sexual and Reproductive Healthcare website for a full list of UKMEC 3 conditions, which are largely for less severe variations of the UKMEC 4 situations.