Synopsis
Use shared decision making and UKMEC 2025 to distinguish method safety from effectiveness, interactions, instructions and patient preferences across contraceptive choices.
- UKMEC 1 means no restriction; 2 means advantages generally outweigh theoretical or proven risks; 3 means risks usually outweigh advantages and specialist judgement plus alternatives are needed; 4 means an unacceptable health risk and the method should not be used.
- UKMEC classifies safety for contraceptive use. It does not select the best method, measure efficacy, account for drug interactions or malabsorption, or provide starting and missed-method instructions.
- Assess pregnancy intention, timing, bleeding goals, STI protection, medical and family history, blood pressure where relevant, smoking, migraine aura, postpartum state, medicines, adherence preferences and ability to stop or remove a method.
Key red flags
Unilateral pelvic pain, collapse, shoulder-tip pain or bleeding with possible pregnancy requires urgent ectopic-pregnancy assessment.
New focal neurology, chest pain, breathlessness or unilateral leg swelling while using oestrogen-containing contraception requires urgent assessment and method review.
Coercion, hidden contraceptive interference, sexual violence or inability to consent changes how privacy, safeguarding and follow-up are arranged.
Current migraine with aura is UKMEC 4 for every combined hormonal route; offer eligible alternatives rather than using a patch or ring to bypass the classification.
Enzyme induction reduces CHC, POP and implant effectiveness but does not reduce copper IUD, LNG-IUD or DMPA effectiveness; apply interaction guidance separately from UKMEC safety.
Unexplained heavy bleeding, a breast mass or liver disease should not be attributed automatically to contraception.
Migraine aura, smoking from age 35, hypertension, VTE history and early postpartum state require exact CHC classification.
Enzyme induction, lamotrigine and medicines with teratogenic potential require contraceptive and reciprocal drug-effect review.
Private discussion may reveal reproductive coercion, adherence barriers, confidentiality needs or a desire for a method hidden from others.
Investigation priorities
Identify UKMEC conditions, interactions, postpartum state and non-contraceptive treatment goals.
Management branches
A person asks for contraception without having selected a method.
- Clarify pregnancy intentions, desired duration, effectiveness priority, bleeding preference, privacy, reversibility and STI prevention.
- Screen medical eligibility and medicines, then present all suitable methods with typical-use demands, benefits, common adverse effects and serious warning symptoms.