Combined pill and UKMEC – Case scenarios.

Assume no other risk factors unless stated.

1. 35 year old patient comes in for her pill check. On enquiry, she admits to smoking 20 per day. She is happy on Microgynon 30. What do you do? P2.

2. 35 year old patient wishes to start COC. On taking a history you note that she suffered from migraine with aura in her teens, but that these have been settled for many years. Is she suitable for this method? P5.

3. A 24 year old non smoker is keen to try COC . Her BMI is 36. How would you advise her? P2.

4. A 30 year old patient asks for COC. On taking a history you discover that her mother had a DVT after a long haul flight at the age of 53. Are you able to prescribe? P4

5. A 20 year old woman wants to start COC, however she is concerned that her mother was diagnosed with breast cancer at the age of 52. Enquiry reveals no other female members of the family affected by breast cancer. Can you safely prescribe the combined pill in this case? P7

Answers to COC and UKMEC.

1. Smoking < 15/day over 35 years is UKMEC 3 and >15/day is UKMEC 4. After stopping smoking for 1 year or more, risk returns to UKMEC 2. Page 2.

2. Unfortunately a previous history of migraine with aura > 5 years ago is UKMEC 3, therefore it is inadvisable to use the COC in this case. Note: that non focal migraine at any age is UKMEC2 for initiation, but UKMEC 3 for continuation. Of course, migraine with aura is UKMEC 4 at any age. Page 5.

3. BMI > 35 is UKMEC 3. Consider also that BMI > 30 is UKMEC 2. Cerazette /cerelle (POP, with a 12 hour window, considered to be of similar efficacy to COC) is UKMEC 1. Therefore, the use of cerazette /cerelle in these cases may be preferable as medically ‘safer’. Page 2.

4. Family history of VTE in first degree relative > 45 years is UKMEC 2. Whereas, first degree relative < 45 years is UKMEC 3. It would be appropriate to supply COC in this case after explanation and discussion and considering other non EE containing methods first. Page 4.

5. FH of breast cancer is UKMEC 1. However, families affected by known gene mutations eg BRAC1 are UKMEC 3. An isolated case within a family is unlikely to be due to inherited gene mutations such as these, therefore, it is appropriate to prescribe the COC in this case. Page 7.