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HIV screening — USMLE Step 3 MCQ

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HardPreventive Medicine, Epidemiology, BiostatisticsHIV screeningUSMLE Step 3

A 37-year-old, nonbreastfeeding patient requests a combined oral contraceptive 35 days after cesarean delivery. BMI is 34 kg/m²; blood pressure is normal, and there is no personal history of venous thromboembolism. How should combined hormonal contraception be classified now under the U.S. Medical Eligibility Criteria?

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Correct answer: B — Category 3: generally avoid combined hormonal contraception during this interval

The best answer is “Category 3: generally avoid combined hormonal contraception during this interval”. From 21 through 42 days postpartum, combined hormonal contraception is U.S. MEC category 3 when an additional venous-thromboembolism risk factor is present. This patient has several listed factors—age at least 35 years, BMI at least 30 kg/m², and cesarean delivery—so the method generally should not be used now when suitable alternatives are available. Nonbreastfeeding status does not remove the early-postpartum thrombotic classification.

Reference: CDC U.S. Medical Eligibility Criteria for Contraceptive Use, 2024—Summary Classifications: https://www.cdc.gov/contraception/hcp/usspr/classifications-mec-contraception.html