Multiple VTE risk factors — DFSRH MCQ

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HardCombined hormonal contraceptionMultiple VTE risk factorsDFSRH

A 39-year-old woman with BMI 34 kg/m2 asks for the patch. She smokes 10 cigarettes daily and her sister had a DVT at age 42. What is the most appropriate management?

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Correct answer: A — Do not prescribe CHC and discuss safer alternatives

The best answer is “Do not prescribe CHC and discuss safer alternatives”. Several UKMEC 3-type risk factors can make CHC clinically unacceptable even if each factor is not UKMEC 4. A lower oestrogen dose or continuous use does not remove thrombotic risk. DFSRH questions often test cumulative risk rather than a single category. Combined hormonal contraception must be assessed by applying oestrogen-related arterial and venous risk, the exact timing of incorrect use, drug interactions and the need for emergency contraception. A non-oestrogen method may be acceptable even when CHC is not. Missed-use advice depends on whether the hormone-free interval was extended, rather than simply on the number of tablets mentioned.

Reference: CoSRH/FSRH, Combined Hormonal Contraception (January 2019, amended October 2023): https://www.cosrh.org/Common/Uploaded%20files/documents/fsrh-guideline-combined-hormonal-contraception-october-2023.pdf