A 36-year-old woman with WHO Medical Eligibility Criteria Category 4 conditions for combined oral contraceptives seeks contraception. Which combination of conditions represents absolute contraindications (WHO MEC 4) to COCs?
- A History of deep vein thrombosis AND migraine without aura
- B Age >35 years AND smoking <15 cigarettes/day
- C History of DVT AND migraine with aura AND current smoker >35 years ✓
- D Breastfeeding at 3 months postpartum AND hypertension with BP 140/90
Correct answer: C. History of DVT AND migraine with aura AND current smoker >35 years
Explanation
WHO MEC Category 4 (absolute contraindication) for COCs includes: current or history of VTE/DVT, migraine with aura (at any age), age >35 with smoking ≥15 cigarettes/day, breastfeeding <6 weeks postpartum, and others. Migraine without aura in women >35 is Category 3 (not 4). History of DVT alone is Category 4. Migraine with aura alone is Category 4. When multiple Category 3–4 conditions coexist, the risk is additive and COCs are clearly contraindicated. Progestogen-only methods (POP, DMPA, implant, LNG-IUS) are safe alternatives for many of these conditions.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.