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Valvular heart disease and CHC — DFSRH MCQ

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HardCombined hormonal contraceptionValvular heart disease and CHCDFSRH

A 33-year-old woman with mechanical mitral valve replacement and warfarin asks for the combined pill. She has heavy bleeding and is worried about pregnancy. What is the most appropriate management?

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Correct answer: C — Avoid CHC and discuss specialist-informed highly effective alternatives

Complex valvular heart disease and anticoagulation require specialist-informed contraception, and CHC is generally avoided because of thrombotic and cardiovascular concerns. Warfarin does not make oestrogen-containing contraception safe. Aspirin is not a workaround, condoms alone may be insufficient where pregnancy is high risk, and repeated EC is not a reliable plan. The pearl is that high-risk cardiac disease needs proactive effective contraception planning.

Reference: UKMEC 2025; FSRH Guideline: Combined Hormonal Contraception