This document updates previous Faculty of Sexual & Reproductive Healthcare (FSRH) guidance and aims to summarise the available evidence on emergency contraception (EC). The guidance is intended for use by health professionals providing EC. If a contraception is used for a non-contraceptive indication (for example management of heavy menstrual bleeding) the risk/benefit profile and eligibility criteria may differ categorised as UKMEC 2 or 3, depending on BMI. These categorisations are primarily because of increased risk of VTE. Known thrombogenic mutations (for example factor V Leiden, prothrombin mutation, protein S, protein C and antithrombin deficiencies) A woman who has had a stroke in the past can generally start and use the progestogen only pill (UKMEC 2 - Initiation) but if she has a stroke while already using it this becomes a UKMEC 3 for Continuation and would require expert clinical management. What does it not do?

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 UKMEC is a set of guidance criteria that enable and support clinicians to deliver safe, evidence-based contraceptive care to women. A woman with a systolic BP greater than 160 or diastolic greater than 100 would be a UKMEC 4 for combined hormonal methods but a 2 for the implant or progestogen only pill.An often repeated saying in sexual and reproductive health care (SRH) is that ‘all modern methods of contraception are very safe, but not all women are safe to use them’. This guidance helps nurses (and doctors) to identify which methods can safely be used by which women and when. Where does it come from? How was it developed? Since its introduction, the UKMEC has become seen as the gold-standard for the safe prescribing of contraception. Anyone who provides contraception services should be familiar with it and have easy access to the summary sheets for everyday reference if seeing people for contraceptive care. For nurses this will most often be when seeing women for repeat pills and injectables. Alongside the method-specific guidance that the FSRH produces this supports clinicians in providing safe and up-to-date, evidence-based care to patients. Which method works best for you depends on a number of factors, including your age, whether you smoke, your medical and family history, and any medicines you're taking.

FSRH CEU Statement to published systematic review: The relationship between progestin hormonal contraception and depression: a systematic review (March 2018) Another notable change is that sterilisation and barrier methods have been removed from the UKMEC 1 as they are comprehensively covered by method-specific guidance produced by the Faculty of Sexual & Reproductive Healthcare (FSRH). 3 , 4 Categories cannot be added together to indicate the safety of using a method. For example, if a woman has two conditions that are each UKMEC2 for use of CHC, these should not be added to make a UKMEC4. However, if multiple UKMEC2 conditions are present that all relate to the 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 combined hormonal contraception (CHC) who has a body mass index (BMI) of 34 kg/m 2 (UKMEC2), is a current smoker (UKMEC2), has a history of superficial venous thrombosis (UKMEC2), and has a first-degree relative who had a venous thromboembolic event at age 50 years (UKMEC2), 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 VTEthe levonorgestrel-releasing intrauterine system (LNG-IUS), contraceptive implants and the progestogen-only pill (POP) are UKMEC 2

the UKMEC categorises all progestogen-only contraceptives and intrauterine contraception as UKMEC 1, which means that there are no restrictions on the use of these methods. FSRH CEU response to European Medicines Agency recommendations regarding use of ulipristal acetate for management of uterine fibroids (February 2018)

Aims of the UKMEC Guideline

FSRH CEU Statement: Response to Study Contemporary Hormonal Contraception and the Risk of Breast Cancer (December 2017) The first UKMEC was adapted from the WHO version in 2005/6 with a similar consensus process using published evidence and the collective knowledge of experts in SRH to reflect current knowledge and practice in the UK. The third edition, published in May 2016, supersedes the second version (2009) and takes into account new evidence included in the WHOMEC (fifth edition). These updates have been led by the Clinical Effectiveness Unit (CEU) of the Faculty of Sexual and Reproductive Healthcare (FSRH). What has changed from the second edition? FSRH CEU Statement : New advice from the MHRA regarding cyproterone acetate: how does this affect prescribing of Co-cyprindiol/Dianette® for acne/hirsutism? July 2020 This authoritative, ‘go-to’ reference for clinicians provides contraceptives safely to women across the life course.