General IM Q37

A 37-year-old woman is evaluated for contraceptive advice. She is married and has a 1-year-old child. The patient describes the conception of this child as an “accident” because she often missed taking her previous oral contraceptive. Her menstrual periods have resumed and are regular but heavy and, in that regard, bothersome to her. Medical history is unremarkable. She drinks a glass of wine every night and smokes a pack of cigarettes daily. She has no other health issues and takes no medications. The result of a pregnancy test performed today is negative. The patient is provided with a brief smoking cessation intervention. She is not ready to stop smoking but will consider it again at a later time.

Which of the following is the most appropriate female contraceptive option for this patient?

A Estrogen-progestin oral contraceptive

B Estrogen-progestin vaginal ring

C Progesterone-containing intrauterine device

D Progesterone-only “mini pill”

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