American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the most appropriate contraceptive option for women at increased risk for venous thromboembolism (VTE)?

1. Progestin-only pills

2. Progestin-releasing intrauterine devices

3. Combined oral contraceptives

4. Implants

The correct answer is: Progestin-releasing intrauterine devices

Progestin-releasing intrauterine devices (IUDs) are considered the most appropriate contraceptive option for women at increased risk for venous thromboembolism (VTE) because they do not contain estrogen, which is associated with a higher risk of VTE. Women who are at an elevated risk for blood clot formation—including those with a history of VTE, certain inherited thrombophilias, or obesity—should avoid methods that contain estrogen, such as combined oral contraceptives. The progestin-releasing IUD provides effective long-term contraception with a low risk of systemic side effects, including the risk of thromboembolic events. Progestin-only pills and implants are also options that do not contain estrogen but may have less favorable continuance rates or potential systemic side effects compared to IUDs. Additionally, progestin-only contraceptives can be less effective than IUDs and require strict adherence to timing, making them potentially less ideal for women needing reliable contraception. In summary, the progestin-releasing IUD stands out as the optimal choice for this population, as it minimizes the risk of VTE while providing effective pregnancy prevention.