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Difficulty: MediumMenstrual Cycle Abnormalities and Contraception

Match each patient's clinical profile with the most appropriate contraceptive method based on the Medical Eligibility Criteria for Contraceptive Use.

  • A 32-year-old female with a history of estrogen receptor-positive breast cancer treated successfully 2 years ago.Copper intrauterine device
  • A 25-year-old female with severe endometriosis and heavy menstrual bleeding who desires long-acting reversible contraception.Levonorgestrel-releasing intrauterine device
  • A 38-year-old female who smokes 1 pack of cigarettes daily and specifically requests a daily oral medication.Progestin-only oral contraceptive pill
  • A 29-year-old female with large submucosal fibroids distorting the uterine cavity and a history of Roux-en-Y gastric bypass.Etonogestrel subdermal implant

Answer

The breast cancer survivor requires the Copper intrauterine device. The endometriosis patient benefits most from the Levonorgestrel-releasing intrauterine device. The 38-year-old smoker should receive the Progestin-only oral contraceptive pill. The bariatric surgery patient with fibroids requires the Etonogestrel subdermal implant.
Each patient's clinical profile presents specific indications or contraindications based on the Medical Eligibility Criteria (MEC). The breast cancer survivor requires a completely hormone-free method (Copper IUD). The endometriosis patient benefits from local progestin to reduce bleeding (Levonorgestrel IUD). The 38-year-old smoker cannot have estrogen but wants a pill, making the progestin-only pill ideal. The patient with gastric bypass (malabsorption) and a distorted uterine cavity needs a non-oral, non-intrauterine method, leaving the etonogestrel implant as the best choice.

Step-by-Step Solution

1
Evaluate the patient with a history of breast cancer.
Identify that all hormonal methods are contraindicated.
Hormone-receptor positive breast cancers can be stimulated by exogenous estrogens and progestins, making non-hormonal methods the only safe choice.
2
Evaluate the patient with endometriosis and heavy menstrual bleeding.
Select a progestin-eluting intrauterine device.
Levonorgestrel intrauterine devices provide excellent contraception while locally thinning the endometrium, which effectively reduces both bleeding and pain.
3
Evaluate the 38-year-old patient who smokes.
Rule out estrogen-containing contraceptives and select a progestin-only pill.
Estrogen in women over 35 who smoke poses an unacceptable risk for myocardial infarction and venous thromboembolism.
4
Evaluate the patient with prior gastric bypass and submucosal fibroids.
Rule out oral pills and intrauterine devices, selecting the subdermal implant.
Gastric bypass impairs oral pill absorption, and an abnormal uterine cavity mechanically prevents safe intrauterine device placement.

Key Concept

Medical Eligibility Criteria for Contraceptive Use
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Topics

Menstrual Cycle Abnormalities and Contraception

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