American Board of Internal Medicine (ABIM) Certification Practice Exam

What is a potential risk of progestin-only contraceptive methods?

1. No increased risk for thrombosis

2. Increased risk of venous thromboembolism

3. Increased risk of hormonal side effects

4. Increased risk of hypertension

The correct answer is: Increased risk of venous thromboembolism

Progestin-only contraceptive methods, such as the mini-pill, certain intrauterine devices (IUDs), and injectables like Depo-Provera, carry specific risks associated with their mechanism of action and effects on the body. While these methods are generally considered to have a favorable safety profile, one potential risk involves hormonal side effects due to the progestin component. However, it is important to distinguish that progestin-only methods do not significantly increase the risk of venous thromboembolism compared to combined hormonal contraceptive methods, which include both estrogen and progestin. The correct answer highlights that progestin-only contraceptive methods do not carry an increased risk for thromboembolism when compared with the baseline risk in the general population. This is a significant consideration in clinical practice, especially for patients who may have a higher baseline risk for thrombotic events due to factors such as obesity, smoking, or previous thrombotic events. In terms of the other options, progestin-only methods may result in side effects like breakthrough bleeding or menstrual irregularities, which may not be classified as severe hormonal side effects. While they are associated with a potential for mild elevations in blood pressure, studies have not shown a consistent,