Question

A 24 year old lactating female with an 18 month old child comes with a history of irregular, heavy bleeding seeking contraceptive advice. Which is the contraceptive of choice?

• A. Progestasert
• B. Copper – T 380A
• C. Mala
• D. Norethisterone enanthate – depot injection

Answer 1

The Correct Option is C

The question revolves around selecting the appropriate contraceptive method for a 24-year-old lactating female with irregular, heavy bleeding. Given the options:

• Progestasert
• Copper – T 380A
• Mala
• Norethisterone enanthate – depot injection

We need to evaluate these based on her current conditions: lactating, experiencing irregular and heavy bleeding, and likely seeking a safe, non-hormonal, or minimally invasive option that would not affect lactation adversely.

Key considerations:

1. Progestasert: It is a hormone-releasing IUD containing progesterone; however, not ideal for those experiencing heavy bleeding as it may not adequately address the bleeding issue.
2. Copper – T 380A: A non-hormonal IUD, but it can potentially increase menstrual bleeding and cramps, which may worsen her condition of heavy bleeding.
3. Mala: An oral contraceptive pill that typically contains a combination of estrogen and progestin. Mala is known for regulating menstrual cycles and reducing menstrual blood flow, making it suitable for irregular and heavy bleeding. Moreover, Mala has been found safe for lactating mothers as it minimally affects milk production.
4. Norethisterone enanthate – depot injection: A progestin-only injectable contraceptive. While it can be beneficial for some, it often does not control bleeding patterns effectively in the short term and might not be the best choice for someone seeking immediate improvement in bleeding.

Conclusion: Considering the need for bleeding regulation and safety during lactation, Mala is the most appropriate contraceptive choice. It offers the additional benefit of managing irregular, heavy bleeding while supporting contraceptive needs and maintaining lactation.