Well - that nails your options somewhat
. Just to be clear - I am NOT advocating any 'orbits', gear up or down. Just forward planning and use of low forward speeds to help you lose the height if you need. That was the only way
I could fly the VOR approach onto R35 in Pristina with a high sector MSA. Nothing else allowed me to achieve the profile and worked out to be the most efficient too.
The technique is really applicable to your 'bullet point' #3 and avoids excessive extension.