Examkin

Question

Difficulty: EasyMenstrual Cycle Abnormalities and Contraception

A 38-year-old woman comes to the clinic to discuss long-term contraceptive options. She recently started a new relationship and does not desire pregnancy. Her medical history is significant for a deep vein thrombosis (DVT) in her right leg 3 years ago after a long-haul flight, for which she completed a 6-month course of oral anticoagulation. She currently takes no medications. She has a 15-pack-year smoking history and continues to smoke one pack of cigarettes daily. Her blood pressure is 122/78 mm Hg, heart rate is 76/min, and body mass index is 27 kg/m². Physical examination reveals normal findings with no leg swelling or tenderness. A urine human chorionic gonadotropin test is negative. She requests a highly effective contraceptive method. Which of the following is the most appropriate contraceptive option for this patient?

  1. Copper intrauterine deviceAnswer
  2. B
    Combined oral contraceptive pills
  3. C
    Transdermal ethinyl estradiol and norelgestromin patch
  4. D
    Ethinyl estradiol and etonogestrel vaginal ring
  5. E
    Condoms and spermicide

Answer

The copper intrauterine device is the safest and most effective option for this patient.
The copper intrauterine device (IUD) is the most appropriate highly effective contraceptive method for this patient. She has two absolute contraindications (WHO MEC Category 4) to estrogen-containing contraceptives: a history of deep vein thrombosis (DVT) and being a smoker over the age of 35. The copper IUD is completely non-hormonal and does not increase the risk of thrombosis, making it a safe (MEC Category 1) and highly effective choice that meets her needs.

Step-by-Step Solution

1
Identify the patient's relevant medical history and demographic risk factors.
The patient is 38 years old, smokes 20 cigarettes (one pack) per day, and has a history of deep vein thrombosis (DVT).
Risk factors determine the Medical Eligibility Criteria (MEC) for various contraceptive methods.
2
Determine the safety of estrogen-containing contraceptives based on her risk factors.
Estrogen is absolutely contraindicated (WHO MEC Category 4) due to both her history of DVT and her age >35 combined with smoking.
Estrogen increases the hepatic synthesis of procoagulant factors, posing an unacceptable risk of recurrent thromboembolism and cardiovascular events in this demographic.
3
Evaluate the contraceptive options to find a highly effective, non-estrogen method.
Combined pills, the patch, and the ring all contain estrogen. Condoms are not highly effective. The copper intrauterine device contains no hormones and is highly effective.
The copper IUD fulfills the patient's request for high efficacy while completely avoiding the thrombotic risks associated with exogenous estrogen.

Key Concept

World Health Organization (WHO) Medical Eligibility Criteria (MEC) establishes that estrogen-containing contraceptives are absolutely contraindicated (Category 4) in women with a history of venous thromboembolism and in women aged 35 or older who smoke 15 or more cigarettes per day.
Estimated Time:45s
Rate this question

Topics

Menstrual Cycle Abnormalities and Contraception

More questions from this topic