Karen, is a 33 year-old G2P2, with a medical history of migraines, for which she takes Imitrex when needed. She has a history of heavy and painful menses each month, lasting approximately 7-8 days. Karen smokes ½ pack of cigarettes per day. Her father has a history of DVT and cardiac disease. Her mother has a history of cervical cancer. Her blood pressure today is 138/76 and her pelvic exam is normal. She is divorced and is sexually active with her new boyfriend. She is currently using condoms for birth control and wants something more reliable. Karen does not desire pregnancy in the near future.
•Discuss the contraceptive methods using the latest evidence-based guidelines that Karen would be medically eligible for.
•Identify one method that you feel would be most beneficial to Karen and discuss why you selected it.
•Are there any methods that you would not recommend for Karen? Why?
Expert Solution Preview
Introduction: As a medical professor, it is important to understand the different contraceptive methods available and their eligibility criteria based on medical history. In this scenario, Karen is seeking a more reliable form of contraception and it is our responsibility to educate her on the various options and assist her in choosing the most suitable method.
Answer:
1. The contraceptive methods that Karen would be medically eligible for include hormonal methods such as combined oral contraceptives, the contraceptive patch, the vaginal ring, and progestin-only methods such as the contraceptive injection, the implant, and the progestin-only pill. Intrauterine devices (IUDs) and barrier methods such as condoms and diaphragms are also eligible for Karen. It is important to assess Karen’s medical history and preferences to determine the most suitable method.
2. The method that would be most beneficial to Karen would be the hormonal intrauterine device (IUD) as it is a highly effective, long-acting reversible contraceptive option that does not require daily administration. It is over 99% effective in preventing pregnancy, and it can also reduce heavy menstrual bleeding. Since Karen experiences heavy and painful menses each month and does not desire pregnancy in the near future, the hormonal IUD would provide her with both contraception and menstrual control.
3. The method that would not be recommended for Karen is the combined hormonal contraceptives such as the combined oral contraceptive pill and the contraceptive patch due to her smoking history. Smoking increases the risk of cardiovascular disease and combined hormonal contraceptives further increase this risk, especially in individuals who smoke more than 15 cigarettes per day and are over the age of 35. Given that Karen smokes half a pack of cigarettes per day and has a family history of cardiac disease, it is important to avoid the combined hormonal contraceptives.
