Chapter 93: Emergency Contraception: Forget Me Not Level II

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LEARNING OBJECTIVES

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

• Describe the advantages and disadvantages of the various options for emergency contraception.

• Discuss the possible side effects and contraindications of the various forms of emergency contraceptives, including both oral and nonoral options.

• Provide patient education regarding the use of emergency contraception.

PATIENT PRESENTATION

Chief Complaint

“I forgot to restart my birth control pill pack. I have gone 9 days without a ‘real’ pill. I’m not ready to be pregnant yet!”

HPI

Olivia Furtel is a 19-year-old woman who presents to the Family Medicine Clinic in a panic. She states that she typically throws out the last week of pills in her pack, “since they are not ‘real’ pills anyway,” and she forgot to start her new pill pack on time. She had intercourse with her husband 2 days ago and wants to know what she should do to avoid pregnancy.

PMH

Seasonal allergies

FH

Mother, age 47, with type 2 diabetes. Father, age 45, with hypertension. Maternal grandmother, age 69, with COPD.

SH

• Denies smoking

• Enjoys an occasional glass of wine

• Married × 1 year—mutually monogamous relationship

Meds

• Cetirizine 10 mg PO once daily × 5 years

• Aviane (ethinyl estradiol 20 mcg/levonorgestrel 0.1 mg) 1 tablet PO once daily × 2 years

All

NKDA

ROS

Patient is a nulligravida woman whose menstrual periods are regular with the use of the combined oral contraceptive pill. She denies any breakthrough bleeding or spotting with routine use. She is tolerating the contraceptive pill well.

Physical Examination

Gen

WDWN female appearing anxious

VS

BP 106/70 mm Hg, P 60 bpm, RR 13, T 37°C; Wt 53.5 kg, Ht 5′5″, BMI 19.6 kg/m²

Skin

Clear

Exam

Deferred; she had a complete examination 3 months ago that was normal

Labs

3 months ago

Negative Pap smear

1 year ago

Tests negative for Chlamydia, gonorrhea, syphilis, and HIV

Assessment

Healthy, sexually active female who missed two doses of her combined oral contraceptive pill, extending her pill-free interval >7 days. Emergency contraceptive options to prevent pregnancy should be discussed.

QUESTIONS