The Medical Eligibility Criteria (MEC) for Contraceptive Use is a system devised by the World Health Organization (WHO) to guide clinicians in the safe prescription of contraceptive methods based on various medical conditions and individual characteristics. Conditions are categorized on a scale from 1 to 4:
- MEC 1: No restriction for the use of the contraceptive method.
- MEC 2: Advantages of using the method generally outweigh the theoretical or proven risks.
- MEC 3: Theoretical or proven risks usually outweigh the advantages of using the method.
- MEC 4: A condition which represents an unacceptable health risk if the contraceptive method is used.
For the Combined Oral Contraceptive Pill (COCP), some MEC 4 contraindications include:
- Migraine
- with aura at any age
- age ≥ 35
- Age ≥ 35 years and smoking ≥ 15 cigarettes per day.
- Diabetes with
- nephropathy/retinopathy/neuropathy
- >20 years’ duration.
- Breast cancer or BRAC1/2 genetics
- < 3-6 weeks post partum (3 if not breast feeding, 6 if breastfeeding but mini pill preferred)
- Cirrhosis (severe) or liver tumor (malignant)
- Vascular
- Hypertension ( ≥160 mm Hg or diastolic ≥100 mm Hg).
- History of DVT or PE (not on anticoagulant therapy).
- Ischemic heart disease.
- Stroke.
- Complicated valvular heart disease.
- Known thrombogenic mutations.
- Systemic lupus erythematosus (SLE) with positive antiphospholipid antibodies.