Contraception is a massive topic for the AKT, and getting your head around the UK Medical Eligibility Criteria (UKMEC) is absolutely essential for those "can this patient have the pill?" style questions.

Let's break this down into the categories, how well these methods actually work, and the key things you need to tell your patients.

1. UKMEC Categories

The UKMEC system (based on FSRH guidelines) tells us how safe a contraceptive method is for a patient with specific medical conditions.

• UKMEC 1: No restriction. Use the method in any circumstances.
• UKMEC 2: Advantages generally outweigh theoretical or proven risks.
• UKMEC 3: Theoretical or proven risks usually outweigh the advantages. Use requires expert clinical judgment.
• UKMEC 4: Unacceptable health risk. The method must not be used.

==High-Yield UKMEC 4 Examples for CHC (Combined Hormonal Contraception):==

• Migraine with aura (at any age)
• Breast cancer (current)
• Smoking ≥15 cigarettes/day AND age ≥35
• History of VTE or stroke
• Blood pressure ≥160/100 mmHg

2. Efficacy Comparison

When counselling, we distinguish between "perfect use" and "typical use." LARC (Long-Acting Reversible Contraception) is the gold standard because it removes user error.

I've put together a comparison table to help you visualize the failure rates (pregnancies per 100 women in the first year).

3. Key Counselling Points

When you're in a consultation, the FSRH recommends a "LARC-first" approach, meaning we should mention the most effective methods first. Here are the "must-know" points for the AKT:

• The Implant: Lasts 3 years. Most common side effect is irregular bleeding (about 1/3 of women).
• The IUS (Mirena): Lasts 5-8 years (depending on the brand). Great for heavy menstrual bleeding (MHB).
• The Copper IUD: Non-hormonal. Can make periods heavier or more painful. It's also the most effective form of emergency contraception.
• The Injectable (Depo-Provera): Given every 13 weeks. Associated with weight gain and a delay in return to fertility (up to 1 year). Long-term use can affect bone mineral density.
• The Combined Pill: Requires a 7-day break (traditionally), but "tailored" or continuous use is now often recommended. Increased risk of VTE and breast/cervical cancer, but decreases risk of ovarian and endometrial cancer.

Mnemonic: ACHES (Warning signs for CHC) Abdominal pain (Gallbladder/Liver) Chest pain (PE/MI) Headaches (Stroke/Migraine) Eye problems (Vascular) Severe leg pain (DVT)

To help you lock this in for your exam, I've found some high-yield lessons and flashcards on these specific UKMEC criteria and counselling scenarios.

Those lessons will give you a deep dive into the specific UKMEC criteria for each condition. To help you memorize the key facts, I've also pulled some flashcards that focus on the most common exam scenarios.

Those flashcards should help you nail the key numbers and categories.

One final tip for the AKT: always check the patient's body mass index (BMI) and blood pressure before prescribing combined hormonal contraception. If the BMI is ≥35, it's a UKMEC 3, and if it's ≥40, it's a UKMEC 4.

If you're feeling confident with the theory, would you like to try a quick quiz to see how you'd handle some clinical scenarios?