A 32-year-old woman with WHO Class III heart disease (Marfan syndrome with aortic root dilation >4 cm) desires contraception. Which method is MOST appropriate?
- A Combined oral contraceptive pill (COCP)
- B Levonorgestrel intrauterine system (LNG-IUS, Mirena) ✓
- C Injectable DMPA (depot medroxyprogesterone acetate)
- D Progestogen-only pill (POP)
Explanation
In women with severe cardiovascular disease (WHO Class III–IV), COCPs are contraindicated (WHO MEC Category 4) due to thromboembolic risk and cardiovascular strain from oestrogen. The LNG-IUS (Mirena) provides highly effective, long-acting, locally-acting progestogen-only contraception with minimal systemic absorption and is WHO MEC Category 1–2 for heart disease. DMPA causes blood pressure elevation and is MEC 3 for some cardiovascular conditions. POP is acceptable (MEC 2) but less effective than LNG-IUS. For Marfan's with aortic dilation, oestrogen-containing contraceptives are absolutely contraindicated.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
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Written and medically reviewed by the StethoPrep medical team.