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 Faculty of Sexual & Reproductive Healthcare (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)
• 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. The categories grade safety, not efficacy, and they cannot simply be added together – but where several risk factors share the same pathway (e.g. venous thromboembolism [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 or 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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