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Postpartum contraception with migraine with aura — USMLE Step 3 MCQ

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HardOB/GYNPostpartum contraception with migraine with auraUSMLE Step 3

A 35-year-old woman presents 6 weeks after delivery and wants contraception. She is breastfeeding, has migraine with aura, and has a history of pulmonary embolism provoked by surgery 5 years ago. Blood pressure is 118/72 mm Hg. She wants a highly effective reversible method. Which of the following is the most appropriate at this time?

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Correct answer: B — Copper intrauterine device

A copper IUD is highly effective, reversible, nonhormonal, and appropriate during breastfeeding. Estrogen-containing contraception is contraindicated with migraine with aura and is also undesirable with a prior venous thromboembolism history.

Reference: CDC U.S. Medical Eligibility Criteria for Contraceptive Use; ACOG contraception guidance