Contraception

Case Study 1

Case Study: Contraception

Scenario 1

Elaine Goodwin is a 38-year-old G5 P5 LC 6 presenting to your clinic today to discuss contraceptive options.  She states that she is not interested in having more children but her new partner has never fathered a child. Her medical history is remarkable for exercise-induced asthma, migraines, and IBS. Her surgical history is remarkable only for tonsils as a child. Her social history is negative for alcohol, tobacco, and recreational drugs.  She has no known drug allergies and takes only vitamin C. Hospitalizations were only for childbirth. Family history reveals that her maternal grandmother is alive with dementia, while her maternal grandfather is alive with COPD. Her paternal grandparents are both deceased due to an automobile accident. Her mother is alive with osteopenia and fibromyalgia, and her dad is alive with a history of skin cancer (basal cell). Elaine has one older sister with no medical problems and one younger brother with no reported medical problems.

• Height 5’ 7” Weight 148 (BMI 23.1), BP 118/72 P 68
• HEENT:  wnl
• Neck: supple without adenopathy
• Lungs/CV: wnl
• Breast: soft, fibrocystic changes bilaterally, without masses, dimpling or discharge
• Abd: soft, +BS, no tenderness
• VVBSU: wnl, except 1st degree cystocele
• Cervix: firm, smooth, parous, without CMT
• Uterus: RV, mobile, non-tender, approximately 10 cm,
• Adnexa: without masses or tenderness

QUESTION:

What other information do you need?

MORE QUESTIONS:

1. What has she used in the past?  Why did she stop a method?  How many partners in past 12 months?
2. What are her current cycles like?
3. When was her last gyn exam and what were the results of the tests?
4. Are her migraines with or without auras?
5. What method has she considered.

QUESTIONS:

•What are your next steps/considerations?

•;What teaching should you do?

•What methods are appropriate for Elaine?