title: Impact of UK Medical Eligibility Criteria implementation on prescribing of combined hormonal contraceptives.
abstract: OBJECTIVE
  Combined 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.
  
  
  METHODS
  A 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).
  
  
  RESULTS
  The 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&emsp14;74&emsp14;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&emsp14;kg/m(2), hypertension and smoking in women aged ≥35&emsp14;years.
  
  
  CONCLUSIONS
  Despite 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.
authors.affiliation: Southport and Ormskirk Hospital NHS Trust, UK. paulaeb@aol.com
authors.forename: Paula Elizabeth
authors.initials: PE
authors.lastname: Briggs
authors.forename: Cecile Aude
authors.initials: CA
authors.lastname: Praet
authors.forename: Samantha Charlotte
authors.initials: SC
authors.lastname: Humphreys
authors.forename: Changgeng
authors.initials: C
authors.lastname: Zhao
mesh_terms: D000293:Adolescent; D000328:Adult; D002318:Cardiovascular Diseases / Q000139:chemically induced; D003277:Contraceptives, Oral, Combined / Q000009:adverse effects; D003430:Cross-Sectional Studies; D004608:Eligibility Determination; D005260:Female; D006801:Humans; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D018570:Risk Assessment; D012307:Risk Factors; D006113:United Kingdom; D055815:Young Adult
chemical_list: D003277:Contraceptives, Oral, Combined
keywords: cardiovascular diseases; family planning service provision; hormonal contraception; obesity; oral contraceptives; smoking