Printed on: June 8th, 2025
Contraceptive medical eligibility criteria (UKMEC)
Contraceptive medical eligibility criteria (UKMEC)
Contraindications for contraception
Contraceptive preparations have potential risks, side-effects and failure rates. Furthermore, certain medical conditions and treatments can affect or be adversely affected by different methods of contraception.
The UK Medical Eligibility Criteria (UKMEC) are guidelines which assist clinicians in prescribing safe and suitable contraceptive options. The recommendations are made by expert working groups based on appraisal of evidence and consensus opinion.
The guidance is aimed at individuals using a method primarily for contraception, i.e. a lifestyle choice for a healthy individual, not to control or treat a medical condition. Medical conditions mean the risk–benefit profile may change.
Background
- In 2000, the World Health Organization (WHO) developed a set of internationally agreed recommendations for providing contraception for individuals with different medical conditions or who were undergoing certain treatments. They are known as the WHO Medical Eligibility Criteria for Contraceptive Use (WHOMEC).
- WHOMEC were designed to be used by international organisations when developing their own guidelines in the context of their own health policies, priorities and resources (WHOMEC 2008).
- The UK-specific Medical Eligibility Criteria (UKMEC) were first published in 2006. These were adapted by the FSRH Clinical Effectiveness Unit (CEU) from the WHOMEC. The latest UKMEC were published in April 2016.
UKMEC categories
The UKMEC categorises the different methods of contraception for different medical conditions, treatments or risk factors. There are four categories:
| UKMEC category | Definition | Which in practice means… |
| 1 | A condition for which there is no restriction of the method. | Always usable |
| 2 | A condition in which the advantages of using the method generally outweigh the theoretical or proven risks. | Broadly usable |
| 3 | A condition where the theoretical or proven risks generally outweigh the advantages of using the method. Use of method not generally recommended unless more appropriate methods not acceptable or available. | Counsel/caution |
| 4 | A condition which represents an unacceptable health risk if the contraceptive method is used. | Do not use |
UKMEC categories are not additive. However, if multiple UKMEC 2 categories co-exist, clinical judgement should be used to decide whether a method is safe. If a patient suffers multiple conditions which are UKMEC 3, use of that method generally becomes a UKMEC 4.
The UKMEC is a guide not a replacement for clinical judgement in individual situations.
UKMEC 2016
The new UKMEC have a different order in which the methods are presented, starting with LARCs, followed by medium- to short-acting methods. This new order reflects the better efficacy of the long-acting methods, and encourages the clinician to consider them as first-line agents (especially in women for whom pregnancy would be high risk).
Some new categories have been introduced to reflect medical conditions relevant to the contraceptive user. These include history of bariatric surgery, organ transplant, cardiomyopathy, arrhythmias and rheumatoid arthritis.
The UKMEC no longer give advice on drug interactions with contraception, and recommend resources such as the FSRH, BNF, SPCs or using online drug information checkers.
Some ‘useful to know' UKMEC
| Intrauterine contraception: UKMEC | ||||
| Method | Condition | UKMEC | Comments | |
| Cu-IUD/IUS | Nulliparity | 1 | IUDs can be fitted in women regardless of age and parity. | |
| Age | <20y | 2 | ||
| ≥20y | 1 | |||
| Postpartum | 48h–4w postpartum | 3 | The concern postpartum is risk of perforation; most practitioners would leave it longer than 4w (usually up to 3m) to reduce this risk further. | |
| >4w postpartum | 1 | |||
| Fibroids | Not distorting cavity | 1 | Some evidence IUS can reduce size and symptoms of fibroids. Even with some distortion, it may be appropriate to attempt an IUS fitting. | |
| Distorting cavity | 3 | |||
| Long QT syndrome | 3 (initiation) |
Concern is about FITTING, not long-term use. Cervical stimulation may result in vasovagal reaction. Resulting bradycardia may increase risk of cardiac event. Fit in a hospital if vasovagal reaction presents particularly high risk of cardiac events. | ||
| IUS only | Breast cancer | Current breast cancer | 4 | Breast cancer may be hormonally sensitive. |
| Breast cancer | PMH <5y ago | 3 | ||
| Progestogen-only contraception (injection (DMPA), progestogen-only pill, subdermal implant): UKMEC | ||||
| Method | Condition | UKMEC | Comments | |
| All | Bariatric surgery (history of) at any current BMI | 1 | UKMEC relate to safety not efficacy. Bariatric surgery could potentially induce a malabsorptive state/cause vomiting which may reduce the efficacy of oral methods. Limited evidence suggests: |
|
| All | IHD/CVA developing while on this method | 3 | - | |
| All | Diabetes mellitus with complications | 2 | Complications means neuropathy, nephropathy, retinopathy and vascular disease. | |
| All | SLE with positive or unknown antiphospholipid antibodies | 2 | - | |
| All | Breast cancer: current | 4 | - | |
| All | High risk of HIV infection | 1 | Some observational data has suggested an association between DMPA use and HIV acquisition. However, this is now thought to be due to confounding factors following a high-quality RCT which observed no difference in HIV acquisition between the different LARC methods. There is now no restriction in use by women deemed at increased risk of HIV (FSRH Statement on updated guidance on contraceptive choice for women at high risk of HIV 2019) | |
| Injection | Age | <18y | 2 | May be a small reduction in BMD in progestogen injection users but this reverses on stopping use. Review method every 2y to discuss ongoing risks and benefits. Stop at age 50y. |
| >45y | 2 | |||
| Injection | Multiple risk factors for vascular disease | 3 | Concerns about effects of low oestrogen states/reduced HDL levels with the injection (so UKMEC 3) but not implant/POP (UKMEC 2). | |
| Injection | Postpartum | <6w | 2 | No evidence progestogen-only contraception affects breast milk or infant growth. |
| Postpartum | ≥6w | 1 | ||
| POP/implant | Postpartum | <6w | 1 | |
| POP/implant | Multiple risk factors for vascular disease | 2 | Concerns about effects of low oestrogen states/reduced HDL levels with the injection (so UKMEC 3) but not implant/POP (UKMEC 2). | |
| Combined hormonal contraception (CHC) (all forms): UKMEC | |||
| Condition | UKMEC | Comments | |
| Weight | BMI <30 | 1 | Risk of VTE increases with BMI. There is no upper limit to BMI in terms of UKMEC so morbid obesity is not an absolute contraindication to CHC unless accompanied by other risk factors. |
| BMI ≥30 | 2 | ||
| BMI ≥35 | 3 | ||
| Bariatric surgery (history of) at any current BMI | As per BMI | UKMEC is determined by the patient's current BMI. Please see notes in progestogen-only contraception section about impact of bariatric surgery on efficacy of oral methods. |
|
| Migraine with aura (N.B. an additional resource at the end of the UKMEC 2016 gives more information on migraine diagnosis) |
4 | CHC use increases stroke risk 2–4x vs. non-use in those with migraine. Auras occur before the onset of headache, last 5–60min and cause: Visual aura: |
|
| Breastfeeding | <6w postpartum | 4 | <21d postnatal: concern about VTE risk because residual prothrombotic state of pregnancy. CHC up to 6w postpartum reduces milk volumes. After 6w, there is no evidence of a detrimental effect on infant growth. |
| ≥6w to <6m postpartum | 2 | ||
| >6m postpartum | 1 | ||
| Postnatal (not breastfeeding) | <3w | 3 | 4 if other risk factors for VTE present. |
| 3–6w | 2 | 3 if other risk factors for VTE present. | |
| ≥6w | 1 | 2 if other risk factors for VTE present. | |
| Smokers: >15 cigarettes/d and ≥35y | 4 | Increased risk of CVD. 35y cut-off because this is the age from which excess mortality from smoking is apparent. Smoker <35y is UKMEC 2 regardless of amount smoked. Risk of CVD gradually declines after stopping and returns to baseline 1–5y after stopping. | |
| Ex-smoker stopped <1y ago and ≥35y | 3 | ||
| BP | BP >140/90 | 3 | CHC users with hypertension have an increased risk of vascular disease. Although treated hypertension should reduce this risk, there is no evidence to support this, so the British Hypertension Society recommends that alternative contraception methods may be more suitable. |
| BP ≥160/100 | 4 | ||
| Controlled hypertension | 3 | ||
| History of high BP in pregnancy | 2 | ||
| Multiple risk factors for CVD | 3 | – | |
| Cardiomyopathy | Normal cardiac function | 2 | – |
| Abnormal cardiac function | 4 | ||
| Diabetes mellitus | Uncomplicated | 2 | Complications means neuropathy, nephropathy, retinopathy and vascular disease. |
| Complicated | 3 | ||
| SLE with positive or unknown antiphospholipid antibodies | 4 | SLE increases the risk of ischaemic and thrombotic vascular disease. | |
| Increased risk breast cancer | FH breast cancer | 1 | In those with a family history of breast cancer, there is no difference in risk between COC users and non-users. This is not the case for carriers of BRCA1 where there may be an increased risk. |
| Carriers of genetic mutations increasing breast cancer risk (BRCA1) | 3 | ||
| Gall bladder disease | Current symptomatic gall bladder disease | 3 | CHCs may increase the risk of developing gall bladder disease and may worsen existing gall bladder disease. |
| Asymptomatic or post-cholecystectomy | 2 | ||
| After surgery | Major surgery with prolonged immobilisation | 4 | Major surgery is >30min operation. CHC should be stopped 4w prior to planned surgery. Neurosurgical, orthopaedic, trauma and general surgical procedures carry an increased risk of VTE. |
| Major surgery without prolonged immobilisation | 2 | ||
| Minor surgery without prolonged immobilisation | 1 | ||
| Immobility (e.g. wheelchair user) | 3 | – | |
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Contraception medical eligibility criteria (UKMEC) |
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Keep the UKMEC summary sheets on your desktop at work. |
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Useful resources: Websites (all resources are hyperlinked for ease of use in Red Whale Knowledge) |
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