contraceptive options
Peer 1
What options are appropriate for this patient?
Margaret is a 40-year-old female smoker that has taken oral contraceptives for the last twenty years. And reports recent marital problems. And she does not feel like she would need birth control but probably should be on something just in case. One of the first steps in determining what contraception to prescribe is to exclude the methods that are contraindicated.
IUD with Levonorgestrel (Mirena) is one of the best choices for patients over 35 years old. And for patients who smoke cigarettes (Woo, 2019). IUDs are not the only estrogen-free choice. However, if the patient is not planning to become pregnant within the next five years. This is a good choice because it would be maintenance-free. And confidential. The healthcare provider inserts this IUD in an office setting. Other options for progestin-only contraception are Depo-Provera injection every three months. Implanon rods are implanted into the arm. And last for three years. And Progestin-only pills (POP) Micronor and Nor-QD that are taken daily (Woo, 2019).
What contraceptive options are contraindicated?
Estrogen is contraindicated in patients over the age of 35. And those who smoke more than 15 cigarettes per day. Oral contraceptive is generally not prescribed to smokers over 35 years of age (Woo, 2019).
What type of patient education is indicated?
Follow up appointment should be made with the provider that inserted the IUD between 3 to 6 weeks to check placement. Education will be provided on this contraception method does not prevent STIs. Serious side effects of IUDs are uterine perforation, expulsion. And uterine infection. The patient should also contact the provider if she changes her mind. And wants to use different contraception.
Given that she has a normal pelvic exam, does that change would that influence your decision?
A normal pelvic exam would make this a better choice for this patient. Since the device will go through the cervix and into the uterus. The cervix did not look irritated on the exam. And would have a better chance of placing the device without any difficulties.
References
Lippincott Williams & Wilkins & Lippincott Williams & Wilkins. (2021). Nursing2022 drug handbook(42nd ed.). Wolters Kluwer Health.
Woo, T. M. (2019). Pharmacotherapeutics for advanced practice nurse prescribers with 3-yr access to davis edge (5th ed.). F. A. Davis Company.
