Introduction: 

This case provides a chance to explore contraceptive options for a sexually active young female, integrating medical history and personal preferences to formulate a suitable contraceptive plan. This teaching case aims to improve your practical knowledge of providing patient-centered contraceptive advice, considering both patient preferences and underlying medical conditions.

Case Profile: 

Ms. Taylor, a 19-year-old G0 woman, visits the clinic seeking information on reliable contraceptive methods. She shares that she is sexually active with her steady boyfriend and uses condoms sporadically "whenever she feels the need." She has never used any other form of contraception. She has been sexually active since she was 16, first with a different partner, and didn't use contraception during those few instances. For the past year, she has been sexually active with her current partner. She is concerned because she had unprotected intercourse four days ago and is worried about a potential pregnancy. She does not desire to become pregnant in the next four years as she gains financial stability. 

She has never undergone a pelvic examination. Her medical history includes an adequately managed seizure disorder and a bout of pyelonephritis at age 12. She's currently taking carbamazepine. She smokes half a pack of cigarettes a day, enjoys social drinking, and occasionally uses marijuana. Her blood pressure is 105/65, and her pulse is 70.

Activity Questions:

• What key historical information should you gather from this patient before recommending suitable contraception? 
  Hint: Consider sexual history, medical history, menstrual history, and future fertility plans:
  • Sexual history
  - Onset of sexual activity
  - Number of partners since the onset
  - History of STIs
  • Medical history – contraindications to estrogen-containing hormonal contraceptives
  - Migraines with aura
  - DVT
  - Uncontrolled hypertension
  - Smoking age > 35
  • Menstrual history
  - LMP (pregnancy)
  - Irregular menses
  • Future fertility plans
  

• What physical examinations and studies are required prior to prescribing hormonal contraceptives? 
  Hint: Think about the relevance of Pap smears, STI screening, and blood pressure monitoring.
  

• Which contraceptive methods would be most suitable for this patient? 
  Hint: Reflect on the pros and cons of various contraceptive methods, considering the patient's medical history and lifestyle.
  

• What is the best way to start the contraceptive method for this patient?
  Hint: Consider the benefits of starting contraception immediately and the different ways to initiate different contraceptive methods.
  

• Given that her last unprotected intercourse was just four days ago, what steps can you take to address her concern about potential pregnancy from that incident? 
  Hint: Consider emergency contraception options and timing.
  

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Interact: 

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