Melissa is a 31-year-old, recently married female who presents to your office for an annual visit. She has three children ages 2, 5, and 8. Her new husband wants to wait at least a year before they try to have a child of their own. She has used combined oral contraceptives ( COCs ) for more than 10 years. Since the birth of her last child, she has been using COCs intermittently. She finds it too difficult to remember to take the pills regularly and wants an easier method. Menses are regular, although her periods seem heavier than usual, and she gets more irritable when she is not taking the COCs . She rarely exercises and admits to smoking and drinking occasionally. She is overweight. She has no medical history. What additional information do you need to obtain? Discuss her options and provide evidence for your rationale. Include patient education in your discussion.
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Contraception correlates with the act of preventing pregnancy. It is mainly indicated for spacing of children, limiting the number of children, and as a public government policy to limit population in addition to preventing the effects of pregnancy on preexisting comorbidities (Bansode et al., 2021). Contraceptive methods which range from behaviors, devices, and medications to procedures allow a woman to regulate her reproductive health and guarantee her an opportunity to participate in her family planning. This assignment will explore contraception based on a case scenario involving Melissa, a 31-year-old female recently married previously on combined oral contraceptives with three living children and desires to conceive after a year. Subsequently, the paper explores additional history to be sought, contraceptive options available, and patient education.
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Additional History
Additional history to be sought from her should be consistent with 2015 WHO guidelines correlating with the Medical Eligibility Criteria for contraceptive use. This will facilitate the choice of an appropriate contraceptive technique according to the aforementioned guidelines. Consequently, Buckingham et al. (2020) recommend inquiry of the following information; a history of allergy to latex or copper, a history of severe cardiovascular disease, history of severe liver disease, history of migraine, previous history of ectopic, prior history of sexually transmitted infections, the number of sexual partners, her HIV status, history of dyslipidemias, her pregnancy status and if breastfeeding. The presence of any of the aforementioned factors necessitates an appropriate choice of contraceptive technique to avoid adverse effects.
Available Options
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Melissa is a 31-year-old, recently married female who presents to your office for an annual visit. She has three children ages 2, 5, and 8. Her new husband wants to wait at least a year before they try to have a child of their own. She has used combined oral contraceptives ( COCs ) for more than 10 years. Since the birth of her last child, she has been using COCs intermittently. She finds it too difficult to remember to take the pills regularly and wants an easier method. Menses are regular, although her periods seem heavier than usual, and she gets more irritable when she is not taking the COCs . She rarely exercises and admits to smoking and drinking occasionally. She is overweight. She has no medical history. What additional information do you need to obtain? Discuss her options and provide evidence for your rationale. Include patient education in your discussion.
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According to Gungor Ugurlucan et al. (2020), the choice of a particular contraceptive method should be based on efficiency, safety, availability, and acceptability. Similarly, Gungor Ugurlucan et al. (2020) further highlight and prioritize efficacy while selecting the contraceptive method. Subsequently, voluntary surgical contraception which is a permanent method is by no means an option for her as she desires another child after one year. Likewise, traditional methods have large failure rates and therefore reduced efficacy. For instance, the failure rate of coitus interruptus is up to 22 % (Bansode et al., 2021). Consequently, implants (Nexplanon), Levonorgestrel intrauterine system (LNG-IUS), copper intrauterine device, injectables, and male condoms are her options in decreasing order of efficacy.
Nexplanon suppresses LH surge, ovulation, and endometrial growth and development have few adverse effects with immediate return to fertility(Emtell Iwarsson et al., 2021). Its irregular bleeding can be corrected by NSAIDs. LNG-IUS which increases the thickness of cervical mucus and suppresses the endometrium has an added advantage as it reduces cramping and heavy bleeding. On the other hand, copper IUD causes an inflammatory reaction that creates a toxic milieu to the fertilized ovum(Emtell Iwarsson et al., 2021). The intrauterine devices have low failure rates and prompt return to fertility upon removal. Melissa can also benefit from the 3-month injectable depot medroxyprogesterone acetate although this is associated with menstrual irregularities and a delayed return to fertility(Buckingham et al., 2020). Finally, barrier methods especially condoms can be of benefit as they prevent both pregnancy and sexually transmitted infections.
Patient Education
Patient education should include an elaborate discussion of the individual side effects associated with the above contraceptive methods and the importance of the involvement of the husband in routine prenatal care. Similarly, Melissa should be educated on the importance of dual protection which prevents both pregnancy and sexually transmitted infections. Furthermore, she should be counseled and encouraged to completely stop smoking and alcohol intake. Finally, she should be advised on weight reduction strategies.
Conclusion
Contraception is a critical component of family planning as well as the reduction of unwanted pregnancies. The healthcare provider should individualize the counseling process to meet the patient’s needs and help the patient select the most suitable contraceptive method.
References
Bansode, O. M., Sarao, M. S., & Cooper, D. B. (2021). Contraception. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK536949/
Buckingham, P., Amos, N., Saha, S. K., Hussainy, S. Y., & Mazza, D. (2020). Contraception decision aids to improve care and effective method use. The Cochrane Library. https://doi.org/10.1002/14651858.cd013659
Emtell Iwarsson, K., Envall, N., Bizjak, I., Bring, J., Kopp Kallner, H., & Gemzell-Danielsson, K. (2021). Increasing uptake of long-acting reversible contraception with structured contraceptive counseling: cluster randomised controlled trial (the LOWE trial). BJOG: An International Journal of Obstetrics and Gynaecology, 128(9), 1546–1554. https://doi.org/10.1111/1471-0528.16754
Gungor Ugurlucan, F., Demir, O., Tas, S., Dural, O., Yasa, C., & Yalcin, O. (2020). Contraception counseling during gynecology visit – does a questionnaire help? Ginekologia Polska, 91(10), 582–588. https://doi.org/10.5603/GP.a2020.0102
Melissa is a 31-year-old, recently married female who presents to your office for an annual visit. She has three children ages 2, 5, and 8. Her new husband wants to wait at least a year before they try to have a child of their own. She has used combined oral contraceptives ( COCs ) for more than 10 years. Since the birth of her last child, she has been using COCs intermittently. She finds it too difficult to remember to take the pills regularly and wants an easier method. Menses are regular, although her periods seem heavier than usual, and she gets more irritable when she is not taking the COCs . She rarely exercises and admits to smoking and drinking occasionally. She is overweight. She has no medical history. What additional information do you need to obtain? Discuss her options and provide evidence for your rationale. Include patient education in your discussion.