Choice C. Condoms with spermicide are a safe, hormone-free option but have the lowest efficacy rate of all contraceptive options. Patients should be placed on the most efficacious contraceptive possible.
Choice D.
Thromboembolic events occur due to a combination of hypercoagulability, endothelial injury, and venous stasis (eg, Virchow triad) with patients typically having more than one risk factor for their development. Women with a pre-existing risk factor for thromboembolism are at increased risk for clot development during pregnancy and with exogenous estrogen exposure due to its hypercoagulable properties.
Antiphospholipid antibody (APS) is an autoimmune disorder characterized by vascular thrombosis and pregnancy complications (eg, recurrent miscarriage, preeclampsia, fetal growth restriction). APS is an absolute contraindication to combined (estrogen/progestin) hormonal contraceptives due to the increased risk of arterial and venous thrombosis (Choices A and B). Patients who desire pregnancy prevention should be offered hormone-free options: the copper intrauterine device or permanent sterilization (eg, tubal ligation).
Educational objective:
Absolute contraindications to combination hormonal contraceptives include a history of antiphospholipid antibody syndrome or thromboembolism. Patients with these conditions should be placed on hormone-free contraceptives (eg, copper intrauterine device).
Choice E. Depo medroxyprogesterone acetate is a systemic progestin-only contraceptive. Progestin-only contraceptives have less risk for thromboembolism compared to combined hormonal options, but systemic forms are still not recommended in high-risk patients.
