A 35-year-old woman with known Factor V Leiden heterozygosity and a past history of DVT wants reliable long-term contraception. She is breastfeeding her 6-week-old infant. The most appropriate contraceptive option is:

• A Combined oral contraceptive pill (COC)
• B Levonorgestrel-releasing intrauterine system (LNG-IUS, Mirena) ✓
• C Etonogestrel implant (Nexplanon)
• D Depot medroxyprogesterone acetate (DMPA) injection

Explanation

COCs are absolutely contraindicated (WHO MEC Category 4) in women with a history of DVT and thrombogenic mutations like Factor V Leiden. Progestogen-only methods are generally Category 2 (benefits outweigh risks) in this setting. Among progestogen-only options, the LNG-IUS is preferred for a breastfeeding woman who wants long-term reversible contraception, as it provides 5 years of efficacy with minimal systemic progestogen absorption, has no clinically significant effect on milk supply after 6 weeks postpartum, and avoids the bone density concerns associated with DMPA.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.