Question of the Week

For January 24, 2017

A 29-year-old woman with a history of obesity, hypothyroidism, and gestational diabetes requests a prescription for contraceptives. She had gestational hypertension during her only pregnancy 3 years ago, but since then, her blood pressure and glycated hemoglobin level have remained normal.

Her only current medication is levothyroxine 125 μg daily by mouth. She has no family history of pulmonary embolism, deep-vein thrombosis, or stroke. Her father has a history of type 2 diabetes, and her mother and maternal aunt have had hypothyroidism and pancreatitis attributed to severe hypertriglyceridemia.

Laboratory testing yields the following results:

Patient value

Reference range

Total cholesterol (mg/dL)

328

125–200

LDL cholesterol (mg/dL)

112

<130

HDL cholesterol (mg/dL)

48

≥46

Triglycerides (mg/dL)

840

<150

Glycated hemoglobin (%)

5.3

3.8–5.6

Thyroid-stimulating hormone (μU/mL)

2.1

0.5–4.7

Which one of the following hormonal contraceptives is most appropriate for this patient?

Combined contraceptive patch
Norethisterone enanthate/estradiol valerate injection
Combined low-dose oral contraceptive pill
Depot medroxyprogesterone acetate
Medroxyprogesterone acetate/estradiol cypionate injection