A 34-year-old woman with two children requests contraception. Her cycles are regular but she loses large volumes of blood each month, and her hemoglobin is 9.5 g/dL. Ultrasound shows a normal uterus with no fibroids. Which single method best addresses both her problems?

• A Combined oral contraceptive pills
• B Copper-T 380A
• C Depot medroxyprogesterone acetate injections
• D Levonorgestrel-releasing intrauterine system ✓

Explanation

The levonorgestrel intrauterine system provides highly effective contraception for 5 years and reduces menstrual blood loss by about 90%, making it first-line for contraception with menorrhagia. Copper IUDs typically increase menstrual bleeding, worsening her anemia. Combined pills help bleeding but are less effective and carry estrogen risks. Depot injections cause amenorrhea in many users but are less suitable as a first choice here and have a slower return of fertility.

Reference: Williams Gynecology, 25th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.