The Medical Eligibility Criteria (MEC) for contraceptive use classifies conditions into 4 categories. A 28-year-old woman had a deep vein thrombosis 14 months ago and recovered fully; she requests combined oral contraceptive pills. What is her MEC category for COC use?
- A MEC Category 4 — absolute contraindication; method must not be used ✓
- B MEC Category 1 — no restriction
- C MEC Category 2 — benefits generally outweigh risks
- D MEC Category 3 — risks generally outweigh benefits; alternative should be offered
Explanation
Past history of deep vein thrombosis (DVT) or pulmonary embolism is a MEC Category 4 condition for combined oral contraceptives (COCs) — meaning COCs must NOT be used regardless of whether the thrombosis was recent or historical (past DVT, not on anticoagulants). The estrogenic component of COCs increases coagulation factor synthesis and inhibits fibrinolysis, substantially raising the risk of recurrent thromboembolism in a woman with a prior VTE history. Progestogen-only pills (POPs), implants, and non-hormonal methods are appropriate alternatives (MEC Category 2 for POP in past DVT history).
Reference: Park's Textbook of Preventive and Social Medicine, 27th ed.
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