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Obesity and CHC eligibility — DFSRH MCQ

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HardUKMECObesity and CHC eligibilityDFSRH

A 42-year-old woman requests the combined pill for cycle control. Her BMI is 38 kg/m2, blood pressure is 134/82 mmHg, she does not smoke, and she has no migraine or VTE history. What is the UKMEC category for combined hormonal contraception?

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Correct answer: E — UKMEC 3

With BMI at this level, CHC is generally UKMEC 3 because the risks usually outweigh benefits, even without smoking or hypertension. UKMEC 2 would fit lower-risk obesity in some circumstances, but this vignette gives BMI 38 kg/m2 as the discriminator. UKMEC 4 is reserved for more serious contraindications such as aura or active/history VTE, and continuous use does not remove thrombotic risk. The pearl is to assess cumulative VTE risk before prescribing CHC for cycle control.

Reference: UKMEC 2025; FSRH Guideline: Combined Hormonal Contraception