The UK Medical Eligibility Criteria for Contraceptive Use (UKMEC) is the framework every contraceptive decision is built on — and it is the single most tested topic across the DFSRH OTA and AHD. If you know the UKMEC table well, you can answer a large proportion of the exam correctly. If you do not, even strong clinical knowledge will not compensate.
The Four Categories
Category 1 — No restriction. The method can be used without restriction in this clinical situation. No special precautions are needed.
Category 2 — Benefits generally outweigh risks. The method can generally be used. The condition should be considered but does not prevent use. May require additional monitoring or follow-up.
Category 3 — Risks generally outweigh benefits. The method is not usually recommended. Use requires careful clinical judgement — only when more appropriate methods are unacceptable or unavailable. Specialist advice may be appropriate.
Category 4 — Unacceptable health risk. The method must not be used. The risk of serious harm outweighs any benefit. This is an absolute contraindication.
The clinical decision point is between Category 2 and Category 3 — this is where the exam tests your nuanced understanding. Category 1 and 4 are usually clear; Category 2 vs 3 requires detailed knowledge of the specific method-condition interaction.
High-Yield UKMEC Scenarios
Combined hormonal contraception (CHC) — the most restricted method:
Category 4 (do not use): migraine with aura at any age, current breast cancer, major surgery with prolonged immobilisation, active DVT/PE, history of ischaemic heart disease or stroke, severe hepatocellular disease, SLE with positive antiphospholipid antibodies, smoking ≥15 cigarettes/day if aged ≥35.
Category 3 (use with caution): smoking <15/day if aged ≥35, BMI ≥35, controlled hypertension, migraine without aura if aged ≥35, immediate postpartum (<21 days) if not breastfeeding, current gallbladder disease.
Category 2: age ≥40 (without other risk factors), BMI 30-34, family history of VTE in first-degree relative, superficial venous thrombosis, uncomplicated valvular heart disease.
Progestogen-only methods — fewer restrictions:
Most conditions that are Category 3/4 for CHC are Category 1 or 2 for progestogen-only methods. Key exception: current breast cancer is Category 4 for all hormonal methods. Progestogen-only methods are generally safe in migraine with aura (Category 1-2), hypertension, smokers, and postpartum/breastfeeding (timing-dependent for some methods).
Intrauterine methods (IUD/IUS):
Category 4 for initiation: current PID, current purulent cervicitis, current STI, known pelvic TB, immediate post-septic abortion. Category 3 for initiation: between 48 hours and 4 weeks postpartum. Category 2: nulliparity, previous ectopic pregnancy, HIV.
Emergency contraception:
Levonorgestrel: very few UKMEC restrictions. Can be used with most conditions. Ulipristal acetate: not recommended with enzyme-inducing drugs (reduced efficacy). Copper IUD: most effective emergency method, but initiation contraindications (above) apply.
The Study Approach
Print the UKMEC summary table (available from the FSRH website — updated 2025). Highlight Category 3 and 4 entries — these are the exam questions. Test yourself daily: pick a clinical condition, and for each contraceptive method, state the UKMEC category.
Use the iatroX DFSRH Q-Bank for scenario-based UKMEC practice. The 850+ questions include extensive UKMEC scenarios that test your ability to apply the categories to specific clinical cases — exactly what the OTA and AHD test. The adaptive spaced repetition ensures the Category 3/4 distinctions are retained under exam pressure.
Know the logic, not just the categories. Understanding why CHC is Category 4 in migraine with aura (increased stroke risk from oestrogen-mediated prothrombotic effects combined with migraine-related vasoconstriction) makes the category memorable and helps you reason through unfamiliar scenarios where you cannot recall the exact category.