Question

Difficulty: EasyMenstrual Cycle Abnormalities and Contraception

Match each patient's clinical presentation with the most appropriate contraceptive method based on efficacy, symptom management, and medical eligibility criteria.

  • 32-year-old woman with heavy menstrual bleeding and anemia, desiring highly effective, long-acting contraception.Levonorgestrel-releasing intrauterine device
  • 29-year-old woman with a history of breast cancer currently in remission, desiring long-acting contraception.Copper intrauterine device
  • 22-year-old woman requesting an oral emergency contraceptive 96 hours (4 days) after unprotected intercourse.Ulipristal acetate
  • 27-year-old woman with a history of migraines with aura who desires a daily oral contraceptive.Progestin-only pill

Answer

Heavy bleeding matches with Levonorgestrel IUD. Breast cancer history matches with Copper IUD. Emergency contraception at 96 hours matches with Ulipristal acetate. Migraine with aura matches with the Progestin-only pill.
Each correct pairing directly applies the Centers for Disease Control and Prevention (CDC) and World Health Organization (WHO) Medical Eligibility Criteria (MEC) for contraceptive use, ensuring patients receive methods that address their specific therapeutic needs (like heavy bleeding) while avoiding methods that pose severe health risks (like hormones in breast cancer or estrogen in migraine with aura).

Step-by-Step Solution

1
Evaluate the patient with heavy menstrual bleeding.
Select the levonorgestrel-releasing intrauterine device.
This device releases local progestin that thins the endometrial lining, significantly reducing menstrual blood loss and correcting anemia.
2
Evaluate the patient with a history of breast cancer.
Select the copper intrauterine device.
Breast cancer is a hormonally sensitive malignancy. All exogenous hormones (estrogen and progestin) are strictly contraindicated. A non-hormonal copper device is required.
3
Evaluate the patient needing emergency contraception at 96 hours.
Select ulipristal acetate.
Standard oral levonorgestrel emergency contraception loses efficacy after 72 hours. Ulipristal acetate maintains efficacy for up to 120 hours.
4
Evaluate the patient with migraines with aura seeking a daily oral pill.
Select the progestin-only pill.
Combined oral contraceptives are contraindicated due to the elevated risk of ischemic stroke associated with estrogen in patients who experience migraine auras. A progestin-only pill is safe.

Key Concept

Applying WHO Medical Eligibility Criteria (MEC) to select safe and appropriate contraceptive methods based on patient comorbidities.
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