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LEARNING OBJECTIVES

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After completing this case study, the reader should be able to:

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  • Discuss the absolute and relative contraindications to the use of hormonal contraceptives.

  • Discuss the advantages and disadvantages of the various forms of contraceptives, including both oral and nonoral hormonal formulations as well as intrauterine devices.

  • Compare and contrast the marketed contraceptive options and be able to select the best product for an individual patient.

  • Develop strategies for managing the possible side effects of oral contraceptives (OCs) and prepare appropriate alternative treatment plans.

  • Provide specific patient education on the administration and expected side effects of selected hormonal contraceptives.

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PATIENT PRESENTATION

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Chief Complaint

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“My fiancé and I are getting married soon, and we’re not ready for kids just yet.”

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HPI

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Macy Madison is a 25-year-old graduate student who presents to the women’s health clinic for contraceptive counseling. She and her fiancé, Fritz, are planning to be married in approximately 4 months. Macy states that she and Fritz have been in a monogamous sexual relationship for the past 3 years, and that their primary method of contraception has been via the inconsistent use of male condoms. She is here today to be evaluated for the use of contraceptives. The patient states she began menses at age 14, with irregular cycles of 25–36 days in length. Her last menses was 2 weeks ago. The patient states she has heard about contraceptive options that “decrease your number of periods,” and she wants to know more about those options, and if they would be okay for her to try.

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PMH

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Migraine headaches without aura or focal neurologic symptoms, well controlled for the past 12 months on prophylactic therapy; no history of HTN, dyslipidemia, or heart disease

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FH

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Mother, age 56, has HTN and osteoporosis and is postmenopausal. Grandmother died from complications of breast cancer, which was diagnosed at age 60. Father, age 58, has osteoarthritis, hypothyroidism, HTN, and dyslipidemia. Grandfather died at age 74 of MI.

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SH

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Currently lives in a house on campus, which she rents with three other graduate students. Once she and Fritz are married, they plan to rent an apartment together until she finishes graduate school. She admits to occasional social use of alcohol (“a few drinks at parties on the weekends”). Otherwise, she denies regular alcohol use during the week. Denies tobacco and illicit drug use.

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Meds

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  • Propranolol LA 160 mg PO once daily for migraine prophylaxis

  • Naproxen 220 mg, one to two tablets PO Q 8 H PRN mild menstrual cramps

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All

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NKDA

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ROS

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Denies excessive vaginal bleeding or significant pelvic pain with menses. Menstrual periods are ...

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