Which of the following are contraindications for combined oral contraceptives? Select all that apply.

Copper intrauterine deviceis a non-hormonallong-acting reversible contraceptive that releases copper ions, creating a spermicidaluterine environment by increasing inflammatory reaction in the endometrium and altering cervical mucus. It is effective for up to 10–12 years, with pregnancy rates <1% per year. Normal menstrual blood loss is 30–40 mL per cycle, and copper IUDs can increase this volume, potentially causing anemia if hemoglobin falls below the normal range of 12–16 g/dL in females.

Rationale for correct answers

1.The copper IUD contains no hormones; contraception is achieved through copper ion release, which is toxic to sperm and ova, preventing fertilization without systemic hormonal effects.

2.Copper IUDs provide long-term contraception for up to 10–12 years, depending on the brand, due to sustained copper ion release maintaining spermicidal activity over time.

4.Copper IUDs have a contraceptive efficacy exceeding 99% due to their continuous local effect on sperm motility and viability, making them among the most effective reversible contraceptive methods.

Rationale for incorrect answers

3.Copper IUDs typically increase, not decrease, menstrual bleeding and cramping, especially in the first months after insertion, due to endometrial inflammation; this contrasts with levonorgestrel IUDs, which can reduce bleeding.

5.Copper IUDs do not require daily monitoring; they only require monthly self-checks for string position and routine medical follow-up, unlike methods such as oral contraceptives that demand daily adherence.

Take home points

• Copper IUDs are hormone-free, highly effective, and long-acting reversible contraceptives.
• They may increase menstrual bleeding and dysmenorrhea.
• Efficacy remains >99% for up to 10–12 years.
• They require minimal maintenance, with only monthly string checks.

1.Breast cancer is a contraindication because COCs contain estrogen and progestin, which can stimulate hormone-sensitive tumors. A history of breast cancer increases recurrence risk with hormonal exposure.

2.Smoking in women over 35 years significantly increases the risk of thromboembolism and myocardial infarction when combined with estrogen-containing contraceptives. This is a well-established absolute contraindication.

4.Hypertension ≥140/90 mmHg is a contraindication due to increased risk of stroke and cardiovascular events with estrogen use. Estrogen promotes sodium retention and increases blood pressure.

Rationale for incorrect answers

3.Nulliparity is not a contraindication. It may be associated with a slightly increased risk of certain cancers, but COCs are safe and often used in nulliparous women for cycle regulation and contraception.

5.Regular menstrual cycles do not contraindicate COC use. In fact, COCs are often prescribed to regulate cycles further or reduce dysmenorrhea. Regularity does not affect safety or efficacy.

Take home points

• COCs are contraindicated in women with hypertension ≥140/90 mmHg due to stroke risk.
• Smoking in women >35 years increases thrombotic risk when using estrogen-containing contraceptives.
• History of breast cancer contraindicates COC use due to hormone sensitivity.
• Nulliparity and regular cycles are not contraindications for COCs.