A 27-year-old woman on sodium valproate is planning pregnancy and asks about contraception. Which method is most appropriate?

• A. Copper intrauterine device
• B. Combined oral contraceptive pill
• C. Progestin-only implant
• D. Barrier methods only

Answer: (A)

The main idea here is choosing a contraception that is highly effective, non-hormonal, and not affected by the anticonvulsant therapy, since valproate is teratogenic and you want to prevent any unintended pregnancy while planning future safe conception.

The copper intrauterine device fits this best. It provides very high contraceptive effectiveness without relying on hormones, so there are no potential interactions with valproate. It’s a long-acting option that works in the uterus itself and does not require daily dosing or adherence. When she’s ready to try to conceive, it can be removed promptly, and fertility returns quickly.

In contrast, hormonal methods like combined oral contraceptives or implants can be subject to drug interactions with anticonvulsants and come with hormonal side effects, which may be less ideal for someone planning pregnancy soon. Barrier methods, while useful, are less reliable with typical use compared with a copper IUD.

So, the copper IUD is the most appropriate choice because it offers highly effective, non-hormonal, long-acting contraception with minimal interaction risk and easy reversibility when pregnancy planning resumes.