A 32-year-old woman with a BMI of 38 kg/m² requests hormonal contraception. She has no other medical conditions. Which combined oral contraceptive pill-related risk is most relevant in her case?

• A Increased risk of cervical carcinoma
• B Increased risk of breast carcinoma
• C Increased risk of venous thromboembolism ✓
• D Reduced efficacy due to increased hepatic metabolism

Explanation

Obesity (BMI ≥30 kg/m²) is an independent risk factor for venous thromboembolism (VTE), and combined oral contraceptives further increase this risk through oestrogen-mediated changes in coagulation factors. The combination of obesity and COC use places this woman at substantially elevated VTE risk — COC is WHO Category 2–3 for obesity depending on degree. Progesterone-only methods or LNG-IUS are preferred. Hepatic metabolism changes do not significantly reduce COC efficacy in obesity.

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

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