Case Study: Contraception
Elaine Goodwin is a 38-year-old G1 P1 LC 1 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, seizure disorder (her last seizure was five years ago), and IBS. Her surgical history 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 Lamictal (lamotrigine) and Trileptal (oxcarbazepine). Hospitalizations were only for childbirth. Family history reveals that her maternal grandmother alive with dementia, while her maternal grandfather is alive 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
Neck: supple without adenopathy
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 8 cm,
Adnexa: without masses or tenderness
What other information do you need?
What has she used in the past? Why did she stop a method? How many partners in past 12 months?
What are her current cycles like?
When was her last gyn exam and what were the results of the tests?
What method has she considered.
Elaine relates to you that she has used birth control pills before but “would keep messing them up”. She has had three partners in last 12 months and has been with her current partner for the previous two months. She believes that he is “the one.”
Elaine relates that her cycles come every 28-32 days, for a duration of 5-8 days, and on her heaviest day she must use a super tampon every hour and get up to change her pad 2-3 times at night. Her last gyn exam was one year ago and she shows you a copy of the results on her patient portal. The results for the pap were NILM, HPV negative, and her cultures for GC/CT were negative. She has heard about an implant that is put in your arm, but her sister had it and she bled all the time.