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Summary for primary care

UK Medical Eligibility Criteria for Contraceptive Use


This Guidelines summary covers the key conditions that women commonly present with in a primary care setting. Please refer to the full guideline for evidence, clarifications, and additional comments associated with the recommendations.

Aims of the UKMEC Guideline

  • The UK Medical Eligibility Criteria for Contraceptive Use (UKMEC) offers guidance to providers of contraception regarding who can use contraceptive methods safely, including by individuals with certain health conditions (for example hypertension) or characteristics (for example age) to prevent an unintended pregnancy
  • These evidence-based recommendations do not indicate a best method for a woman nor do they take into account efficacy—and this includes drug interactions or malabsorption
  • The guidance does not indicate a best method for a woman nor do they take into account efficacy (and this includes drug interactions or malabsorption).

Using the UKMEC Tables


  • The first column indicates the condition. Each condition is defined as representing either an individual’s characteristics (for example age, parity) or a known pre-existing medical condition (for example diabetes, hypertension). Some conditions are subdivided to differentiate between varying degrees of the condition (for example migraine with or without aura).

Methods of Contraception

  • The tables in this Guidelines summary considers the following methods of contraception:
    • copper-bearing intrauterine device (Cu-IUD)
    • levonorgestrel-releasing intrauterine system (LNG-IUS)
    • progestogen-only:
      • implant (IMP)
      • injectable (DMPA)
      • pill (POP)
    • combined hormonal contraception (CHC)
  • Please refer to the full guideline for the UKMEC table for emergency contraception
  • Please note that the contraceptive methods are now reordered (from left to right) in the tables to broadly reflect long-acting/more effective to shorter acting/less effective methods. This is a key change from the previous edition of the UKMEC guidance.


Category 1A condition for which there is no restriction for the use of the method
Category 2A condition where the advantages of using the method generally outweigh the theoretical or proven risks
Category 3A condition where the theoretical or proven risks usually outweigh the advantages of using the method. The provision of a method requires expert clinical judgement and/or referral to a specialist contraceptive provider, since use of the method is not usually recommended unless other more appropriate methods are not available or not acceptable
Category 4A condition which represents an unacceptable health risk if the method is used
  • The category (UKMEC1 to UKMEC4) for each condition is given for each method of contraception. Occasionally, NA (not applicable) is used, which denotes a condition for when a ranking was not given but clarifications have been provided in the full guideline
  • The definitions of the categories are given in the tables in this Guidelines summary
  • If a contraception is used for a non-contraceptive indication (for example management of heavy menstrual bleeding) the risk/benefit profile and eligibility criteria may differ
  • Categories cannot be added together to indicate the safety of using a method. For example, if a woman has two conditions that are each UKMEC2 for use of CHC, these should not be added to make a UKMEC4. However, if multiple UKMEC2 conditions are present that all relate to the same risk, clinical judgement must be used to decide whether the risks of using the method may outweigh the benefits. For example, consider a 34-year-old woman wishing to use combined hormonal contraception (CHC) who has a body mass index (BMI) of 34 kg/m2 (UKMEC2), is a current smoker (UKMEC2), has a history of superficial venous thrombosis (UKMEC2), and has a first-degree relative who had a venous thromboembolic event at age 50 years (UKMEC2), all potential risk factors for venous thromboembolism (VTE). She might be better advised to consider a different method of contraception that does not increase her risk of VTE
  • When an individual has multiple conditions all scoring UKMEC3 for a method, use of this method may pose an unacceptable risk; clinical judgement should be used in each individual case.

Initiation and Continuation of a Method

  • The initiation (I) and continuation (C) of a method of contraception can sometimes be distinguished and classified differently (see tables in this Guidelines summary). The duration of use of a method of contraception prior to the new onset of a medical condition may influence decisions regarding continued use. However, there is no set duration and clinical judgement will be required.

Drug Interactions with Hormonal Contraception

  • Drug interactions can potentially cause adverse effects. Health professionals providing hormonal contraception should ask women about their current and previous drug use including prescription, over-the-counter, herbal, recreational drugs, and dietary supplements. Women should be advised to use the most effective methods for them; this may include the additional use of non-hormonal barrier methods when potential drug interactions pose concern
  • For further information on drug interactions, please refer to:

Personal Characteristics and Reproductive History

AgeMenarche to <20=2,≥20=1Menarche to <20=2, ≥20=1After menarche=1Menarche to <18=2, 18-45=1, >45=2After menarche=1Menarche to <40=1, ≥40=2
(a) Nulliparous111111
(b) Parous111111
(a) 0 to <6 weeks postpartumSee below1214
(b) ≥6 weeks to <6 months (primarily breastfeeding)1112
(c) ≥6 months1111
Postpartum (in non-breastfeeding women)
(a) 0 to <3 weeks
(i) With other risk factors for VTESee below1214
(ii) Without other risk factors1213
(b) 3 to <6 weeks
(i) With other risk factors for VTESee below1213
(ii) Without other risk factors1112
(c) ≥6 weeks  1111
Postpartum (in breastfeeding or non-breastfeeding women, including post caesarean section)
(a) 0 to <48 hours11See above
(a) 0 to <48 hours33
(c) ≥4 weeks11
(d) Postpartum sepsis44
(a) First trimester111111
(b) Second trimester221111
(c) Post-abortion sepsis441111
Past ectopic pregnancy111111
History of pelvic surgery (including caesarean section)111111
(a) Age <35 years111112
(b) Age ≥35 years
(i) <15 cigarettes/day111113
(ii) ≥154 cigarettes/day111114
(iii) Stopped smoking <1 year111113
(iv) Stopped smoking ≥1 year111112
(a) BMI ≥30–34 kg/m2111112
(b) BMI ≥35 kg/m2111113
History of bariatric surgery
(a) With BMI <30 kg/m2111111
(b) With BMI ≥30–34 kg/m2111112
(c) With BMI ≥35 kg/m2111113
Please refer to the full guideline for recommendations on organ transplant
BMI=body mass index; NA=not applicable; VTE=venous thromboembolism.

Cardiovascular Disease

Multiple risk factors for CVD (such as smoking, diabetes, hypertension, obesity and dyslipidaemias)122323
Cardiac arrhythmias
(a) Atrial fibrillation122224
(b) Known long QT syndromeICIC1212
(a) Adequately controlled hypertension111213
(b) Consistently elevated BP levels (properly taken measurements)
(i) Systolic >140–159 mmHg or diastolic >90–99 mmHg111113
(ii) Systolic ≥160 mmHg or diastolic ≥ 100 mmHg111214
(c) Vascular disease122324
History of high BP during pregnancy111112
Current and history of ischaemic heart disease1ICIC3IC4
Stroke (history of cerebrovascular accident, including TIA)1ICIC3IC4
Known dyslipidaemias122222
Venous thromboembolism
(a) History of VTE122224
(b) Current VTE (on anticoagulants)122224
(c) Family history of VTE
(i) First-degree relative age <45 years111113
(ii) First-degree relative age ≥45 years111112
(d) Major surgery
(i) With prolonged immobilisation122224
(ii) Without prolonged immobilisation111112
(e) Minor surgery without immobilisation111111
(f) Immobility (unrelated to surgery) (for example wheelchair use, debilitating illness)111113
Superficial venous thrombosis
(a) Varicose veins111111
(b) Superficial venous thrombosis111112
Known thrombogenic mutations (for example factor V Leiden, prothrombin mutation, protein S, protein C and antithrombin deficiencies)122224
Valvular and congenital heart disease
(a) Uncomplicated111112
(b) Complicated (for example pulmonary hypertension, history of subacute bacterial endocarditis)221114
(a) Normal cardiac function111112
(b) Impaired cardiac function222224
Cardiac arrhythmias
(a) Atrial fibrillation122224
(b) Known long QT syndromeICIC1212
CVD=cardiovascular disease; BP=blood pressure; TIA=transient ischaemic attack; VTE=venous thromboembolism.

Neurological Conditions

(a) Non-migrainous (mild or severe)11111IC
(b) Migraine without aura, at any age1222ICIC
(c) Migraine with aura, at any age122224
(d) History (≥5 years ago) of migraine with aura, any age122223
Idiopathic intracranial hypertension111112
Taking anti-epileptic drugsCertain anti-epileptic drugs have the potential to affect the bioavailability of steroid hormones in hormonal contraception. For up-to-date information on the potential drug interactions between hormonal contraception and anti-epileptic drugs, please refer to the online drug interaction checker available on the Medscape website ( interaction checker)

Depressive Disorders

Depressive disorders111111

Reproductive Tract Conditions

Vaginal bleeding patterns
a) Irregular pattern without heavy bleeding112221
b) Heavy or prolonged bleeding (includes regular and irregular patterns)2IC2221
Unexplained vaginal bleeding (suspicious for serious condition) before evaluationICIC3322
Cervical cancer
(a) Awaiting treatmentICIC2212
b) Radical trachelectomy332212
Endometrial cancerICIC1111
Uterine fibroids
a) Without distortion of the uterine cavity111111
b) With distortion of the uterine cavity331111
Anatomical abnormalities
a) Distorted uterine cavity33 
b) Other abnormalities22 
Pelvic inflammatory disease
a) Past PID (assuming no current risk factor for STIs)111111
b) Current PIDICIC1111
Sexually transmitted infections (STIs)
a) Chlamydial infection (current)ICIC    
i) Symptomatic42421111
ii) Asymptomatic32321111
b) Purulent cervicitis or gonorrhoea (current)42421111
  • Please refer to the full guideline for recommendations on:
    • endometriosis
    • benign ovarian tumours (including cysts)
    • severe dysmenorrhoea
    • gestational trophoblastic disease
    • cervical ectropion
    • cervical intraepithelial neoplasia
    • ovarian cancer
    • other current STIs (excluding HIV and hepatitis)
    • current vaginitis (including Trichomonas vaginalis and bacterial vaginosis)
    • increased risk for STIs
PID=pelvic inflammatory disease.

Breast Conditions

(a) Undiagnosed mass/breast symptoms12222IC
(b) Benign breast conditions111111
(c) Family history of breast cancer111111
(d) Carriers of known gene mutations associated with breast cancer (for example BRCA1/BRCA2)122223
(e) Breast cancer
(i) Current breast cancer144444
(ii) Past breast cancer133333


HIV Infection
(a) High risk of HIV infection111111
(b) HIV infected
(i) CD4 count ≥200 cells/mm3221111
(ii) CD4 count <200 cells/mm3ICIC1111
(c) Taking antiretroviral drugsCertain ARV drugs have the potential to affect the bioavailability of steroid hormones in hormonal contraception. For up-to-date information on the potential drug interactions between hormonal contraception and ARV drugs, please refer to the online HIV drugs interaction checker (
(a) Non-pelvic111111
(b) PelvicICIC1111
Viral hepatitis
(a) Acute or flare11111IC
(b) Carrier111111
(c) Chronic111111

Endocrine Conditions

(a) History of gestational disease111111
(b) Non-vascular disease
(i) Non-insulin dependent122222
(i) Insulin dependent122222
(c) Nephropathy/retinopathy/neuropathy122223
(d) Other vascular disease122223
Please refer to the full guideline for recommendations on thyroid disorders

Gastrointestinal Conditions

Thyroid disease
a) Symptomatic
i) Treated by cholecystectomy122222
ii) Medically treated122223
iii) current122223
b) Asymptomatic122222
History of cholestasis
a) Pregnancy related111112
b) Past COC related122223
a) Mild (compensated without complications)111111
b) Severe (decompensated)133334
Please refer to the full guideline for recommendations on liver tumours and inflammatory bowel disease

COC=combined oral contraceptive


Please refer to the full guideline for recommendations on thalassaemia, sickle cell disease, and iron deficiency anaemia

Rheumatic Diseases

Rheumatoid arthritis122222
Systemic lupus erythematosus (SLE)
(a) No antiphospholipid antibodies122222
(b) Positive antiphospholipid antibodies122224
Positive antiphospholipid antibodies122224