Patient Information: 38-Year-Old Female Contraception Discus

Response 1patient Informationeg 38 Femalesccdiscuss Contracept

Patient information: E.G., a 38-year-old female presenting to discuss contraceptive management options. She is a G5P5006, with a history of migraines, exercise-induced asthma, IBS, and prior tonsillectomy. She is currently not using any contraceptive method, does not want more children, and has a new partner who has not fathered children. Her recent medical history includes fibrocystic breast changes and a first-degree cystocele. Physical exam reveals a BMI of 23.1, soft breasts with fibrocystic changes, and a stage 1 cystocele. Diagnostic assessments include urine HCG, pelvic exam, breast exam, and STI screening.

The primary concern is to select an appropriate contraceptive method in light of her medical history and reproductive preferences. Considering her migraines, cystocele, and overall health, we evaluate several options. Combined hormonal contraceptives are generally contraindicated due to the increased stroke risk associated with migraines with aura, but progestin-only methods, such as the depo shot, the Mirena IUD, or oral progestins, are safer and effective for her. Counseling about natural family planning, though least effective, can be considered if she prefers non-hormonal options, but with limitations in efficacy. Barrier methods and tubal sterilization remain options if preferred. Additionally, due to her cystocele, pelvic floor therapy is recommended to strengthen support and alleviate any discomfort.

Contraceptive counseling should include discussion of each method’s benefits, risks, and suitability, especially considering her migraine history. Since she is cautious about hormonal therapy, progesterone-only options or intrauterine devices are optimal. She is advised to avoid pregnancy until her cystocele improves, and she plans to think about her choice at home, with a follow-up appointment scheduled in two weeks or sooner if needed.

Paper For Above instruction

Contraceptive management is a crucial aspect of reproductive health, influenced by individual medical history, patient preferences, and risk factors. For a 38-year-old woman presenting with specific medical concerns, a tailored approach ensures safety and efficacy.

Her medical history, including migraines, especially if they are with aura, significantly influences contraceptive options. Evidence indicates that combined hormonal contraceptives, particularly estrogen-containing methods, increase the risk of thromboembolism in women with migraines with aura (Lidegaard et al., 2012). Therefore, progestin-only contraception becomes preferable. The depo shot (medroxyprogesterone acetate), Mirena intrauterine device (IUD), and oral progestins such as norethisterone are viable options that provide effective pregnancy prevention with a minimized risk profile (Larsen et al., 2014).

Additionally, her cystocele, a mild prolapse of the bladder into the anterior vaginal wall, warrants pelvic floor therapy to improve support and address symptoms such as vaginal pressure or urinary issues. Pelvic floor strengthening not only alleviates discomfort but also potentially enhances her ability to utilize certain contraceptive methods comfortably. Imaging, such as pelvic ultrasound, may be considered if symptoms worsen or to assess prolapse severity further (Makajeva et al., 2022).

Her fibrocystic breast changes are benign, common, and often hormone-sensitive. Regular monitoring and breast self-exams are recommended. No immediate intervention is necessary unless she experiences significant pain or palpable masses (American Cancer Society, 2022). Routine screening according to guidelines should continue, with mammography starting at age 50 unless she has high-risk factors.

In terms of contraceptive counseling, it is essential to discuss the various methods, their efficacy, safety, and suitability considering her health conditions. Barrier methods, such as male or female condoms, are non-hormonal but less effective and dependent on consistent use. Tubal sterilization is a permanent solution, appropriate for women who are certain they do not want future pregnancies. Hormonal options must be selected cautiously; progesterone-only pills, injections, or IUDs are safer choices for women with migraines (Lodi & Advani, 2018).

Natural family planning (NFP) may be an option if she prefers non-hormonal methods but is aware of its limited efficacy and requires intensive monitoring and education. The effectiveness of NFP varies, and it demands high motivation and understanding of fertility cycles (Hassoun, 2018). The choice should align with her comfort level, lifestyle, and reproductive goals.

Patient education is vital. She should be informed about potential side effects, contraindications, and the importance of follow-up, especially if using hormonal methods. Given her migraines, ongoing assessment of headache patterns and risk evaluation is prudent. Additionally, counseling should include discussion about STI screening, especially since her current partner's status is unknown, along with routine gynecologic exams and Pap smears (WHO, 2020).

In conclusion, her contraceptive plan should prioritize safety considering her migraine history, address her prolapse with pelvic floor therapy, and be aligned with her reproductive intentions. Shared decision-making and follow-up are integral to ensuring optimal outcomes and satisfaction with chosen contraceptive methods.

References

• American Cancer Society. (2022). Fibrocystic Breast Disease. Cancer.org. https://www.cancer.org
• Larsen, M. B., et al. (2014). Contraceptive choices for women with migraine: A review. Journal of Women's Health, 23(3), 220-226.
• Lidegaard, Ø., et al. (2012). Oral contraceptives and risk of stroke: A systematic review. BMJ, 345, e7624.
• Lodi, M., & Advani, S. (2018). Hormonal contraception in women with migraine: Risks and benefits. The Medical Journal of Australia, 209(7), 278-283.
• Makajeva, E., et al. (2022). Pelvic organ prolapse: Evaluation and management. Obstetrics and Gynecology Clinics, 49(1), 115-129.
• Malherbe, J., et al. (2022). Fibrocystic breast changes: Pathophysiology and management. Current Oncology Reports, 24(4), 369-377.
• Pescador, J., & De Jesus, G. (2022). Migraines and hormonal influences: An overview. Headache, 62(2), 122-134.
• Reddy, A., et al. (2021). Estrogen and migraine pathogenesis: A systematic review. Menopause, 28(7), 776-784.
• World Health Organization. (2020). Family planning/contraception. WHO guidelines on reproductive health. https://www.who.int