A 26-year-old woman with a history of superficial venous thrombosis (not deep vein thrombosis) requests combined oral contraceptive pill (COCP). Which is the most accurate statement regarding WHO Medical Eligibility Criteria (MEC) category for COCPs in this patient?

• A WHO MEC Category 2 — advantages generally outweigh risks; COCP acceptable
• B WHO MEC Category 4 — unacceptable health risk; COCPs absolutely contraindicated
• C WHO MEC Category 3 — risks generally outweigh benefits; alternative methods should be discussed ✓
• D WHO MEC Category 1 — no restriction on use of the method

Explanation

According to WHO MEC 2015 (5th edition), superficial venous thrombosis (superficial thrombophlebitis of leg veins) is classified as Category 3 for combined hormonal contraceptives — meaning risks generally outweigh benefits and alternative methods should be used. This is because COCPs increase VTE risk (approximately 3-6 fold), and a history of superficial VT may indicate underlying coagulation abnormality or increased risk for DVT. In contrast, deep vein thrombosis or pulmonary embolism (current or past) is Category 4 (absolute contraindication). Progestogen-only methods are Category 2 for superficial VT, making them the preferred alternative.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

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Written and medically reviewed by the StethoPrep medical team.