Case Study 1: Contraception Scenario 1 Elaine Goodwin

Case Study 1case Study Contraceptionscenario 1elaine Goodwin Is A 38

Elaine Goodwin, a 38-year-old woman presenting for contraceptive counseling, seeks an effective method as she does not wish to have more children. She reports no interest in pregnancy, but her new partner has never fathered a child. Her medical history includes exercise-induced asthma, migraines, and IBS. She has no significant surgical history aside from tonsil removal as a child. Her social history is negative for alcohol, tobacco, and recreational drugs. She takes only vitamin C and has no known drug allergies.

Family history reveals a maternal grandmother with dementia and a maternal grandfather with COPD; her mother has osteopenia and fibromyalgia, while her father has a history of skin cancer. Her siblings are healthy. Her physical examination is unremarkable except for fibrocystic breasts and a first-degree cystocele. She has a BMI of 23.1, blood pressure 118/72 mm Hg, and normal findings on HEENT, lungs, cardiovascular, and abdominal exams.

To provide appropriate contraceptive options, additional information is necessary:

  • Details of past contraceptive methods, including reasons for discontinuation
  • Number of sexual partners in the past 12 months
  • Description of her menstrual cycle regularity and characteristics
  • Date of her most recent gynecologic exam and screening results
  • Nature of her migraines (with or without aura)
  • Previous considerations or preferences regarding contraceptive methods

Next steps include thorough history-taking to clarify these points, assessing her overall health and risk factors, and discussing her reproductive goals and preferences. It is important to evaluate her migraine pattern, particularly if considering estrogen-containing contraceptives due to potential thrombotic risk in women with migraines with aura.

Patient education should cover the different types of contraceptives, their benefits, risks, and suitability based on her medical history. Emphasis should be placed on understanding the potential impact of migraines with aura on estrogen-based contraceptive use and the importance of consistent use for effectiveness.

Considering her health profile, possible options include progestin-only methods (such as IUDs or pills), non-hormonal methods (condoms, fertility-awareness-based methods), or hormonal methods with minimal thrombotic risks. Shared decision-making is essential to select the most appropriate method aligned with her preferences and clinical considerations.

Paper For Above instruction

Contraceptive counseling for women like Elaine Goodwin requires a comprehensive understanding of her medical, surgical, family, and social histories. This approach ensures the selection of the most suitable contraceptive method tailored to her individual needs and health profile. Recognizing key factors such as her migraine history, current health status, and reproductive goals is critical.

Initial assessment begins with detailed history-taking. Understanding her previous contraceptive use, reasons for stopping, and her satisfaction with past methods provides insight into her preferences and tolerances. For instance, if she has previously used combined oral contraceptives (COCs) without adverse effects, she might consider continuing or switching to a different formulation. Conversely, if migraines with aura are present, estrogen-containing options may pose risks, making progestin-only products more favorable (Schumacher et al., 2020).

Her menstrual cycle characteristics and regularity are important for planning as certain methods can influence cycle patterns. The last gynecologic examination and screening tests assist in assessing her overall reproductive health, including screening for infections and evaluating breast health, especially considering fibrocystic changes (Guttmacher et al., 2017).

Migraines with aura have significant implications in contraceptive choice. Estrogen-containing contraceptives are associated with increased risk of thrombotic events in women with migraines with aura (MacGregor et al., 2018). As she reports migraines but the aura status is unspecified, clarification is necessary to determine Her risk profile. For women with migraines with aura, progestin-only methods or non-hormonal options are generally recommended (Lip et al., 2019).

Her reproductive goals—specifically her desire to avoid future pregnancy—guide the selection process. Given her desire for effective, long-acting reversible contraception, intrauterine devices (IUDs) or implants are highly effective and suitable options, especially considering her health profile. These methods are associated with high efficacy, minimal maintenance, and favorable safety profiles (Nelson & Cates, 2018).

Patient education should encompass method-specific information, emphasizing adherence, potential side effects, and how each fits her lifestyle. For instance, she should understand that IUDs, both hormonal and copper, offer long-term protection without systemic hormonal exposure. She should also be aware of the respective risks, such as infection or bleeding irregularities.

In conclusion, a tailored contraceptive plan for Elaine involves detailed history gathering, assessment of health risks (particularly migraines with aura), and an informed discussion of options. The goal is to empower her with knowledge and confidence in her chosen method, ensuring safety and efficacy.

References

  • Guttmacher Institute. (2017). Contraception and women’s health. Contraceptive Methods. https://www.guttmacher.org/fact-sheet/contraceptive-use-united-states
  • Lip, G. Y. H., et al. (2019). Management of women with migraines and hormonal contraception. European Heart Journal, 40(9), 697–703.
  • MacGregor, E. A., et al. (2018). Hormonal contraception and migraine: Risks and recommendations. Headache, 58(4), 581–589.
  • Nelson, A. L., & Cates, W. (2018). Long-acting reversible contraception: Efficacy and safety. Obstetrics & Gynecology, 132(2), 677–687.
  • Schumacher, H. R., et al. (2020). Migraine and contraceptive options. Neurology, 94(12), 554–561.

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