A 35-year-old parous woman with dysmenorrhea and menorrhagia requests a long-acting reversible contraceptive that also treats her menstrual symptoms. The most appropriate device is:

• A Copper intrauterine device (Cu-IUD)
• B Levonorgestrel-releasing intrauterine system (LNG-IUS, Mirena) ✓
• C Etonogestrel subdermal implant (Implanon)
• D Depot medroxyprogesterone acetate (DMPA) injection

Explanation

The levonorgestrel-releasing intrauterine system (LNG-IUS 52 mg, Mirena) is uniquely suited for this patient: it provides highly effective long-acting reversible contraception (>99%) while also treating heavy menstrual bleeding (reduces blood loss by 90-95%) and dysmenorrhoea via local progestogenic effects causing endometrial atrophy and reduced prostaglandin synthesis. Copper IUD worsens menorrhagia. The subdermal implant causes unpredictable bleeding patterns. DMPA can reduce bleeding but is not a device and causes bone density concerns with long-term use.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.