What is the safest contraception option for a woman with a history of pulmonary embolism (PE) who is not being treated with anticoagulants?

Safest Contraception for Women with History of PE Not on Anticoagulation

For a woman with a history of pulmonary embolism who is not on anticoagulant therapy, the Levonorgestrel IUD (LNG-IUD) is the safest contraceptive option, making statement B TRUE. 1

Analysis of Each Statement

Statement B: LNG-IUD for History of PE (TRUE)

The U.S. Medical Eligibility Criteria classifies the LNG-IUD as Category 2 for women with a history of DVT/PE not on anticoagulation therapy, meaning the advantages generally outweigh the theoretical or proven risks. 1

• For women with lower risk for recurrent DVT/PE (no additional risk factors), the LNG-IUD receives a Category 2 classification, which is the most favorable rating among hormonal contraceptives for this condition 1
• In contrast, combined hormonal contraceptives (pills, patches, rings) receive a Category 3 or 4 classification for this same condition, meaning risks usually outweigh benefits or represent an unacceptable health risk 1
• The copper IUD is also Category 2, but the LNG-IUD offers additional benefits for women on anticoagulation therapy by reducing menorrhagia and preventing hemorrhagic ovarian cysts 1, 2
• Research confirms that the LNG-IUD is a first-line contraceptive method for women with history of deep venous thrombosis or pulmonary embolism 2

Statement A: Patch for 10-Year Diabetes (FALSE)

• The contraceptive patch (combined hormonal method) is not automatically contraindicated in women with 10 years of diabetes 1
• Classification depends on the presence of vascular complications: diabetes without vascular disease receives Category 2 (benefits generally outweigh risks), while diabetes with vascular complications receives Category 3-4 1
• Duration alone (10 years) does not determine contraindication; the presence of nephropathy, retinopathy, neuropathy, or other vascular disease is what matters 1

Statement C: Combined Pills for Controlled Hypertension (FALSE)

• Well-controlled hypertension does not automatically make combined oral contraceptives have risks that outweigh benefits 1
• The U.S. Medical Eligibility Criteria distinguishes between adequately controlled hypertension (Category 3) and uncontrolled hypertension (Category 4) 1
• For adequately controlled and monitored hypertension, combined hormonal contraceptives may still be used with careful consideration, though progestin-only methods are preferred 1

Statement D: Antibiotics with Hormonal Contraception (FALSE)

• Broad-spectrum antibiotics do not have more risk than benefit when used with hormonal birth control 1
• While rifampin and rifabutin can reduce contraceptive efficacy, most broad-spectrum antibiotics do not significantly interact with hormonal contraceptives 1
• This statement represents an outdated concern that has not been supported by evidence 1

Key Clinical Considerations

Women with history of VTE should avoid all estrogen-containing contraceptives (pills, patches, rings), as these carry Category 3-4 classifications indicating unacceptable risk. 1, 3

• Estrogen-containing contraceptives increase VTE risk approximately 2-6 fold over baseline 3
• The LNG-IUD and other progestin-only methods are not associated with significant increases in VTE risk 3
• For women with higher risk for recurrent DVT/PE (known thrombophilia, active cancer, history of recurrent DVT/PE), even the LNG-IUD should be used with caution 1