Examkin

Question

Difficulty: HardMenstrual Cycle Abnormalities and Contraception

A family planning clinic is evaluating multiple patients who are seeking reliable, reversible contraception. Each patient has distinct medical comorbidities that impact the safety of various contraceptive methods according to the World Health Organization Medical Eligibility Criteria (WHO MEC). Match each patient's clinical presentation with the single most appropriate contraceptive method.

  • A 34-year-old woman with poorly controlled hypertension (162/104 mmHg) and severe dysmenorrhea.Levonorgestrel-releasing intrauterine device
  • A 28-year-old woman with systemic lupus erythematosus and positive antiphospholipid antibodies.Copper intrauterine device
  • A 22-year-old woman with active Chlamydia trachomatis cervicitis who requests a long-acting contraceptive today.Subdermal etonogestrel implant
  • A 38-year-old woman who smokes a pack of cigarettes daily and specifically requests a daily, orally administered contraceptive.Progestin-only pill (Norethindrone)

Answer

The hypertensive patient with dysmenorrhea should receive the Levonorgestrel-releasing intrauterine device. The patient with SLE and antiphospholipid antibodies should receive the Copper intrauterine device. The patient with active cervicitis should receive the Subdermal etonogestrel implant. The 38-year-old smoker desiring an oral method should receive the Progestin-only pill.
Each patient presentation highlights a specific WHO MEC Category 4 (absolute) or Category 3 (relative) contraindication. Estrogen is contraindicated in severe hypertension and in smokers over age 35. All hormones are contraindicated in patients with positive antiphospholipid antibodies. IUD placement is contraindicated during active cervical infections.

Step-by-Step Solution

1
Evaluate the patient with severe hypertension and dysmenorrhea.
Exclude estrogen-containing methods; select a method that treats dysmenorrhea.
Estrogen exacerbates cardiovascular risk in severe hypertension. The levonorgestrel IUD provides excellent contraception while treating heavy or painful menses.
2
Evaluate the patient with SLE and positive antiphospholipid antibodies.
Exclude all hormonal (estrogen and progestin) methods.
Positive antiphospholipid antibodies confer an unacceptably high risk of thrombosis with hormonal methods. The copper IUD is the safest highly effective, hormone-free alternative.
3
Evaluate the patient with active cervicitis seeking a long-acting method.
Exclude all intrauterine devices; select the subdermal implant.
Inserting an IUD through an infected cervix can seed bacteria into the upper genital tract, causing pelvic inflammatory disease. The implant provides immediate, long-acting protection without this risk.
4
Evaluate the 38-year-old smoker requesting a daily pill.
Exclude combined oral contraceptives; select the progestin-only pill.
Age 35 or older combined with heavy smoking creates an unacceptable risk for myocardial infarction and stroke if given estrogen. The progestin-only pill meets her preference for a daily oral formulation safely.

Key Concept

World Health Organization Medical Eligibility Criteria (WHO MEC) for Contraceptive Use
Rate this question

Topics

Menstrual Cycle Abnormalities and Contraception

More questions from this topic