A 28-year-old woman with a history of deep vein thrombosis presents for contraceptive counselling. She is 6 weeks postpartum and not breastfeeding. The safest highly effective contraceptive option is:

• A Combined oral contraceptive pill (COCP) as she is postpartum and not breastfeeding
• B Depot medroxyprogesterone acetate (DMPA) injection
• C Copper intrauterine device (Cu-IUD) ✓
• D Levonorgestrel intrauterine system (LNG-IUS)

Explanation

Combined oral contraceptives (COCPs) containing oestrogen are absolutely contraindicated (WHO MEC Category 4) in women with personal history of DVT/PE due to markedly elevated thromboembolism risk. Progestin-only methods (DMPA, LNG-IUS, progestin-only pill) are generally MEC Category 2 (benefits outweigh risks) with DVT history. However, the copper IUD provides highly effective non-hormonal contraception (>99%) with no thrombotic risk — it is MEC Category 1 (no restriction) in women with DVT history, making it the safest option in this scenario.

Reference: Park's Textbook of Preventive and Social Medicine, 27th ed.

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Written and medically reviewed by the StethoPrep medical team.