GPAtlas🧭 Choosing a contraceptive method (UKMEC)
Selecting contraception is a shared decision: matching an individual’s preferences and reproductive goals to a method that is safe for their medical history. Safety is judged against the UK Medical Eligibility Criteria (UKMEC) – now in its 2025 edition, published by the College of Sexual and Reproductive Healthcare (CoSRH), formerly the FSRH. Efficacy and acceptability are then layered on top: there is no single “best” method, only the safest effective method an individual will actually use.
Two groups deserve particular care: those with existing medical conditions (where a method may be contraindicated), and women aged over 40, where cardiovascular risk rises, bleeding patterns change, and the rules for when to stop contraception come into play.
UKMEC grades each method against each condition from 1 to 4. Crucially, the categories grade safety, not efficacy, and they cannot simply be added together – but where several risk factors share the same pathway (e.g. VTE), clinical judgement is needed.
| UKMEC category | Definition | In practice |
|---|---|---|
| 1 | No restriction for use | Use freely |
| 2 | Advantages generally outweigh risks | Broadly usable; review where multiple 2s coexist |
| 3 | Risks usually outweigh advantages | Caution – expert judgement / specialist input; use only if better options unacceptable |
| 4 | Unacceptable health risk | Do not use |
The single most common high-stakes error is overlooking an absolute contraindication to combined hormonal contraception (CHC) – especially migraine with aura. When in doubt about oestrogen, a progestogen-only or intrauterine method is almost always safe.
Source: FSRH/CoSRH UKMEC 2025
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