Impact of UK Medical Eligibility Criteria implementation on prescribing of combined hormonal contraceptives

Abstract

ObjectivesCombined hormonal contraceptives (CHCs) are the most widely prescribed contraceptive methods in the UK; however, their use is associated with significant cardiovascular risk for women with some medical conditions and risk factors. The objective of this study was to assess the potential change in CHC prescribing among higher-risk women following publication of the UK Medical Eligibility Criteria for Contraceptive Use (UKMEC) in 2006.MethodsA cross-sectional study was conducted using the General Practice Research Database to analyse UK women aged 15–49 years who were prescribed CHCs during the period 2004–2010. Of women prescribed CHCs, those at higher risk of cardiovascular events (with UKMEC Category 3 or 4 risk factors) were identified. The percentage of higher-risk CHC users, among all CHC users, in 2005 (pre-UKMEC) was compared to that in 2010 (post-UKMEC).ResultsThe percentage of higher-risk CHC users significantly decreased by 0.8% (95% CI 0.68% to 1.02%) following publication of UKMEC [8.1% (95% CI 7.98% to 8.22%) in 2005 vs 7.3% (95% CI 7.14% to 7.38%) in 2010; p<0.001]. However, an estimated 1 74 472 women in the UK were prescribed CHCs in 2010 despite having Category 3 or 4 risk factors. The most common Category 3 or 4 risk factors were body mass index ≥35 kg/m2, hypertension and smoking in women aged ≥35 years.ConclusionsDespite the observed reduction in prescribing of CHCs to higher-risk women after publication of UKMEC, a large number of women with Category 3 or 4 risk factors are still prescribed CHCs. The increased risk of cardiovascular events is unnecessary for many of these women given the availability of alternative contraceptive methods.

Hormonal contraception in women with migraine: is progestogen-only contraception a better choice?

“…In the context of migraine and CHCs use, it is very important to remember that the World Health Organization Medical Eligibility Criteria for Contraceptive Use stated that MA at any age is an absolute contraindication to the use of COCs (WHO Category 4) [46]. The US/WHO MEC is more restrictive than the UK/WHO MEC as regard to MO, rating CHCs as a category 4 for any migraineur over age 35 [47]. That being so, the personal risk assessment should guide the prescription of CHCs in selected conditions.…”

Uso seguro de anticoncepcionais hormonais injetáveis segundo critérios médicos de elegibilidade / Safe use of injectable hormonal contraceptives according to medical eligibility criteria

“…12 A study conducted in the United Kingdom found that with the use of WHO-endorsed WHO, there was a decrease in combined hormonal contraceptive prescriptions for women who were in Categories 3 and 4 for MAC use, however, the method was still prescribed for women who possessed Risk of developing cardiovascular disease. 13 Often, the small range of contraceptive methods in health services justifies this reality, as well as the client's resistance to changing methods.…”

Commentary on ‘Prescribing patterns of combined hormonal products containing cyproterone acetate, levonorgestrel and drospirenone in the UK’

“…In 2013 Briggs et al 4 determined a statistically significant reduction in the number of higher-risk users (women who were deemed to have a condition which is a UKMEC Category 3 or 4 for CHC use) from 2005 to 2010 following the publication of the UKMEC in 2006. Given that different databases [THIN and GPRD (General Practice Research Database)] were utilised, this study would have provided an opportunity for comparison.…”