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Smoking and combined contraception — DRCOG MCQ

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ModerateContraception and Sexual HealthSmoking and combined contraceptionDRCOG

A 37-year-old smoker requests combined hormonal contraception. She smokes 20 cigarettes daily, BMI is 25 kg/m² and blood pressure is 124/78 mmHg. She has no migraine. What would you advise?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: E — Avoid combined hormonal contraception and discuss safer alternatives

Age 35 or over with heavy smoking makes combined hormonal contraception unsafe because of cardiovascular risk. Normal blood pressure does not remove this risk. The pearl is that contraception should not be delayed; safer alternatives such as intrauterine or progestogen-only methods can be offered while supporting smoking cessation.

Reference: FSRH UKMEC 2025; FSRH Combined Hormonal Contraception