MEC Category for Contraceptive Patch in a 30-Year-Old Nulliparous Woman Who Smokes
The contraceptive patch is MEC Category 2 for this patient, meaning the advantages of using the method generally outweigh the theoretical or proven risks. 1
Rationale Based on Current Guidelines
The 2024 U.S. Medical Eligibility Criteria provides clear classification for combined hormonal contraceptives (CHC), which includes the contraceptive patch, based on two relevant patient characteristics:
Age Classification
- For women aged <40 years, CHCs (including the patch) are classified as Category 1 (no restriction for use) 1
- At age 30, this patient falls well within the unrestricted age category 1
Smoking Status Classification
- For women who smoke and are age <35 years, CHCs are classified as Category 2 1
- This means the benefits generally outweigh the risks, though smoking does add some theoretical cardiovascular risk 1
Parity Status
- Nulliparity is Category 1 for CHCs, meaning it poses no restriction 1
- Parity status does not affect the safety profile of the contraceptive patch 1
Key Clinical Considerations
The critical factor here is the combination of smoking with age <35 years. While smoking increases cardiovascular risk with CHC use, the absolute risk remains low in women under 35 years old 1. Evidence demonstrates that COC users who smoke have increased risk for cardiovascular diseases, especially myocardial infarction, with risk increasing with the number of cigarettes smoked per day 1.
The classification would change to Category 3 or 4 if:
- She were ≥35 years old and smoking <15 cigarettes/day (Category 3) 1
- She were ≥35 years old and smoking ≥15 cigarettes/day (Category 4) 1
Clinical Pitfall to Avoid
Do not confuse this patient with someone over 35 who smokes—that would be a completely different risk category. At age 30, even with smoking, the patch remains a reasonable contraceptive option (Category 2), though smoking cessation counseling should be provided 1.
Answer: B. 2