The UKMEC (UK Medical Eligibility Criteria for Contraceptive Use) is the framework for every contraceptive prescribing decision. It is tested extensively in the DRCOG — and the questions that candidates most commonly get wrong are the Category 3 vs Category 4 distinctions for combined hormonal contraception.
The Categories
Category 1: No restriction. Category 2: Benefits outweigh risks. Category 3: Risks generally outweigh benefits (use with caution). Category 4: Unacceptable risk (do not use).
The exam tests Category 3 and 4 — the clinical situations where your prescribing decision directly determines patient safety.
CHC (Combined Hormonal Contraception) — The Most Restricted Method
Category 4 (absolute contraindication): Migraine with aura (any age), current breast cancer, active VTE/PE, history of ischaemic heart disease or stroke, SLE with positive antiphospholipid antibodies, smoking ≥15/day if ≥35, severe hepatocellular disease, major surgery with prolonged immobilisation.
Category 3 (relative contraindication): Smoking <15/day if ≥35, BMI ≥35, controlled hypertension, migraine without aura if ≥35, <21 days postpartum (non-breastfeeding), current gallbladder disease, history of breast cancer (no recurrence for 5 years).
Progestogen-Only Methods — Fewer Restrictions
Most conditions that are Category 3/4 for CHC are Category 1 or 2 for POP, implant, injectable, and IUS. Key exception: current breast cancer remains Category 4 for all hormonal methods. Depo-Provera is Category 3 for under-18s and over-45s (BMD concerns).
IUD/IUS — Initiation Contraindications
Category 4 for initiation: current PID, current STI, current purulent cervicitis, immediate post-septic abortion, pelvic TB, uterine distortion incompatible with insertion. Category 3 for initiation: 48 hours to 4 weeks postpartum.
Emergency Contraception
Levonorgestrel: very few UKMEC restrictions. Ulipristal: not recommended with enzyme-inducing drugs. Copper IUD: most effective but initiation Category 4 conditions apply.
How to Memorise
Focus on the CHC Category 4 list — these are the absolute contraindications. Learn them as a list: migraine with aura, breast cancer, VTE/IHD/stroke, antiphospholipid SLE, heavy smoking over 35, liver disease, immobilisation.
Then learn the Category 3 entries — the "grey zone" where the exam tests your nuanced judgement.
The iatroX DFSRH/DRCOG Q-Bank includes extensive UKMEC scenario questions that build pattern recognition through adaptive spaced repetition — so the categories become automatic rather than requiring deliberation under exam pressure.