A 42-year-old G4P3104 presents for her well-woman examination. She has had three vaginal deliveries and one cesarean delivery for breech presentation. She states her cycles are regular and reports no history of sexually transmitted infections. Currently she and her husband use condoms, but they dislike the hassle of a coital-dependent method. She is interested in a more effective contraception because they do not want any more children. She reports occasional migraine headaches, and had a serious allergic reaction to anesthesia as a child when she underwent a tonsillectomy. She drinks and smokes socially. She weighs 78 kg, and her blood pressure is 142/89 mm Hg. During her office visit, you counsel the patient at length regarding birth control methods.
Which of the following is the most appropriate contraceptive method for this patient?
A. Intrauterine deviceAn intrauterine device is a highly effective longterm method for which the patient has no contraindication. A bilateral tubal ligation would be another option; however, the patient had a serious allergic reaction to anesthesia as a child, and general anesthesia is required for female laparoscopic sterilization. The patient’s smoking and age contraindicate the use of combination oral contraceptives. Migraine headaches accompanied by neurologic symptoms such as loss of vision, paresthesias, and numbness are generally considered to be a contraindication to combination oral contraceptive use. Use of a diaphragm is a coital-dependent action and the patient relates that it is not something she desires.