A 26-year-old woman comes to the physician requesting advice regarding contraception. She previously used condoms but stopped using them a few weeks ago after a condom broke during intercourse. Today, she is interested in other contraceptive options and has asked for a "more reliable and uncomplicated contraceptive method." She was diagnosed with deep vein thrombosis 2 years ago. Her menses occur at regular 30-day intervals with normal flow. Medical history is otherwise unremarkable and she takes no medications. She does not smoke cigarettes. She is sexually active with one male partner and uses condoms inconsistently. Vital signs are within normal limits. Pelvic examination shows no abnormalities. A urine pregnancy test is negative. Which of the following is the most appropriate recommendation regarding contraception for this patient?

Question

Quizplus · Accepted Answer

Eductional Objective: A copper intrauterine device (IUD) is an appropriate contraceptive option for patients with contraindications for estrogen-based contraceptives. Besides a history of thromboembolism (e.g., deep vein thrombosis), contraindications for these hormonal contraceptives include pregnancy, lactation, hypertension (systolic > 160 mm Hg or diastolic > 100 mm Hg), migraine with aura, hepatic dysfunction (e.g., due to cirrhosis), hepatic neoplasm, breast cancer, estrogen-dependent neoplasms, and smoking in individuals > 35 years of age. Patients with any of these contraindications may use nonhormonal contraceptives (e.g., copper IUDs, barrier contraception), as well as progestin-only hormonal contraceptives (e.g., minipill, subdermal progestin implant, progestin IUD). This patient, who would like a reliable and uncomplicated contraceptive, may benefit most from a copper IUD, which is highly effective and appropriate for long-term use (up to 10 years).
Contraindications for a copper IUD include known or suspected pregnancy, menorrhagia, or dysmenorrhea, none of which are seen in this patient.

A 26-Year-Old Woman Comes to the Physician Requesting Advice Regarding