In patients with risk factors where estrogen-containing therapies are of concern, which contraception method is preferred?

• A. Copper IUD is safe in all estrogen scenarios
• B. Progestin-only methods may be preferred in certain conditions
• C. Estrogen-containing methods are avoided in smokers over 35, thromboembolic risk, or certain hypertension
• D. Barrier methods are always preferred

Answer: (B)

When estrogen-based contraception poses a risk, the goal is to prevent pregnancy without adding estrogen exposure. Progestin-only methods achieve this by providing effective contraception while avoiding estrogen, making them the preferred option for people with factors like smoking over 35, a history of thromboembolism or other cardiovascular risk, or certain hypertension scenarios. They also offer advantages for breastfeeding, since estrogen can interfere with milk production and progestin-only options don’t carry that same concern. Long-acting progestin methods (like the implant or LNG-containing IUD) are especially convenient and reliably avoid systemic estrogen.

While nonhormonal options such as a copper IUD don’t introduce estrogen, they aren’t universally the best choice for every patient with estrogen-related risk factors, and some individuals may have contraindications or personal preferences that steer them toward progestin-only options. Barrier methods, though safe from an estrogen standpoint, tend to have higher typical-use failure rates and are not considered the preferred approach when a more reliable, estrogen-sparing option is appropriate.