A 34-year-old woman with PCOS, BMI 36 kg/m², and chronic anovulatory amenorrhea has an endometrial thickness of 15 mm on ultrasound. She does not want pregnancy for several years, dislikes daily medication, and declines the combined pill because of migraine with aura. The BEST option to protect the endometrium while providing contraception is:

• A Medroxyprogesterone acetate 10 mg for 12 days every 3 months
• B Metformin 1500 mg daily
• C Levonorgestrel-releasing intrauterine system ✓
• D Combined oral contraceptive pill with strict blood pressure monitoring

Explanation

Chronic anovulation leaves the endometrium under unopposed estrogen, and a 15 mm thickness signals hyperplasia risk. The levonorgestrel intrauterine system delivers high local progestogen, induces glandular atrophy, reverses simple hyperplasia, and simultaneously gives highly effective contraception, suiting her poor compliance and her avoidance of estrogen. Intermittent quarterly progestogen courses protect less reliably in a woman who forgets tablets, and metformin improves insulin sensitivity but does not provide dependable endometrial protection.

Reference: Jeffcoate's Principles of Gynaecology, 8th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.