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CHC and superficial thrombophlebitis — DFSRH MCQ

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HardCombined hormonal contraceptionCHC and superficial thrombophlebitisDFSRH

A 33-year-old non-smoker requests initiation of combined hormonal contraception. Duplex ultrasonography one week ago confirmed thrombosis confined to a superficial varicose tributary, with no extension into the deep venous system. She has no current or previous DVT or pulmonary embolism, no known thrombophilia, and no family history of venous thromboembolism. Her BMI is 24 kg/m² and her blood pressure is 124/78 mmHg. Under UKMEC, which category applies to initiation of CHC because of her superficial venous thrombosis?

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Correct answer: D — UKMEC 2

The correct answer is D: UKMEC 2. FSRH UKMEC deliberately separates venous disease into varicose veins (UKMEC 1 for CHC) and superficial venous thrombosis (UKMEC 2 for CHC), reflecting a modestly increased thrombotic risk that is generally outweighed by the advantages of the method. Option C incorrectly applies the classification for uncomplicated varicosities; the Doppler-confirmed thrombus places her in the higher category. Option A is wrong because UKMEC classifies the condition (including a history of superficial venous thrombosis) rather than transient symptoms, so resolution of pain does not restore category 1. Option B (UKMEC 3) overstates the restriction—category 3 is not assigned to isolated superficial venous thrombosis. Option E (UKMEC 4) is reserved for current or previous DVT/PE and major thrombophilic states such as known thrombogenic mutations, none of which is present here.

Reference: Faculty of Sexual and Reproductive Healthcare. UK Medical Eligibility Criteria for Contraceptive Use (UKMEC 2016), Summary Table – Personal characteristics and reproductive history: Superficial venous thrombosis (CHC column). https://www.rightdecisions.scot.nhs.uk/media/1614/fsrh-ukmec-summary-pages-2017.pdf