A 32-year-old woman with severe thrombophilia (antiphospholipid antibody syndrome, prior DVT) requires effective contraception. She is breastfeeding a 6-week-old infant. Which of the following contraceptive options is most appropriate?
- A Combined oral contraceptive pill (COC)
- B Desogestrel-containing progestogen-only pill (POP)
- C Levonorgestrel intrauterine device (LNG-IUD, Mirena) ✓
- D Copper intrauterine device (Cu-IUD)
Explanation
In women with antiphospholipid antibody syndrome (APAS) and prior DVT, estrogen-containing contraception (COC, combined patch, vaginal ring) is absolutely contraindicated (WHO MEC Category 4) due to the additive thrombotic risk. Progestogen-only methods are generally acceptable. The LNG-IUD (Mirena) provides excellent efficacy (~99.8%), mainly acts locally (minimal systemic progestogen), does not affect coagulation significantly, and is compatible with breastfeeding. Desogestrel POP (WHO MEC 2 for APAS) is an alternative, but systemic progestogen absorption is higher than LNG-IUD. Copper IUD is also highly effective and hormone-free, making it a strong option too; however, the LNG-IUD has the additional benefit of reducing menstrual blood loss which is relevant in a woman who may already have coagulopathy-related bleeding concerns.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
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Written and medically reviewed by the StethoPrep medical team.