Best Contraceptive Method After Molar Pregnancy Evacuation
Oral contraceptive pills (OCPs) are the preferred contraceptive method following evacuation and curettage for molar pregnancy, as hormonal contraception is specifically indicated during postmolar follow-up to maintain the reliability of hCG monitoring, which is essential for detecting gestational trophoblastic neoplasia. 1
Rationale for Hormonal Contraception
Hormonal contraception is explicitly indicated during the entire postmolar follow-up period to ensure reliable hCG tumor marker monitoring, which is the most sensitive method for early detection of gestational trophoblastic neoplasia 1, 2
OCPs do not increase the risk of postmolar trophoblastic disease—studies show 18.9% of OCP users developed postmolar GTN compared to 14.3% using barrier methods (not statistically significant), and hCG regression times were equivalent at 7.0 versus 7.2 weeks 3
OCPs can be safely prescribed immediately after molar evacuation and continued throughout the entire interval of gonadotropin monitoring 3
Why Not IUD After Molar Pregnancy
The IUD is contraindicated in the immediate postmolar period based on specific guideline recommendations:
The CDC Medical Eligibility Criteria classifies IUD use as Category 3 (risks usually outweigh benefits) when β-hCG levels are decreasing or undetectable after molar pregnancy 4
IUD use is Category 4 (unacceptable health risk) when β-hCG levels are persistently elevated or malignant disease is present 4
While limited evidence suggests IUDs don't increase risk of postmolar trophoblastic disease, the classification reflects concerns about infection risk and the need for reliable hCG monitoring without interference 4
The IUD would likely need removal if treatment for GTN becomes necessary, leaving the patient at pregnancy risk during the critical surveillance period 4
Clinical Implementation
Weekly hCG measurement is essential after evacuation to confirm remission and identify cases requiring chemotherapy 1
Postmolar follow-up should extend for 1 month after remission for partial moles and 3-6 months after remission for complete moles 1
The NCCN guidelines recommend hCG monitoring every 1-2 weeks until normalized (3 consecutive normal assays), then twice at 3-month intervals 4
Answer to Question
A. OCP is the correct answer. Oral contraceptive pills are specifically indicated to maintain reliable hCG monitoring during the critical postmolar surveillance period, are safe (not increasing GTN risk), and can be initiated immediately after evacuation. IUDs are contraindicated (Category 3-4) in this clinical scenario according to CDC guidelines.