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Smoking age over 35 and CHC — DFSRH MCQ

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ModerateCombined hormonal contraceptionSmoking age over 35 and CHCDFSRH

A 37-year-old woman using a combined oral contraceptive pill attends for a repeat prescription. She smokes 12 cigarettes daily, has blood pressure 126/78 mmHg, and has no migraine. What is the UKMEC category for combined hormonal contraception?

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Correct answer: E — UKMEC 3

Age 35 or older with smoking under 15 cigarettes daily is generally UKMEC 3 for CHC. UKMEC 4 is more consistent with heavier smoking at this age or other major contraindications. Nicotine replacement counselling is useful but does not reclassify current smoking status at the consultation. The pearl is that smoking risk changes categorically after age 35.

Reference: UKMEC 2025; FSRH Guideline: Combined Hormonal Contraception