Case 054: Contraception

PATIENT PRESENTATION

Chief Complaint

Are my new medications okay to use with my old ones?

History of Present Illness

Patient recently suffered a broken foot, post-surgery, and developed an infection. She is being discharged from the hospital on antibiotics, pain medications and her oral contraceptive and GERD medication that she was taking prior to admission.

Link to EMR

Student Work-Up

TARGETED QUESTIONS

1. What hormonal contraceptive drug interactions are present in this patient?

   Hint: See Table 49-5 in PPP

2. What alternative contraceptive products may be used for this patient?

   Hint: See Treatment in PPP

3. If the patient wants to continue her oral contraceptive, how long will the patient need to use an alternative contraceptive method?

   Hint: See Table 49-5 in PPP

4. What risks and adverse effects of hormonal contraceptives would you discuss with this patient?

   Hint: See Table 49-4 in PPP

5. How do the patient’s needs influence the choice of hormonal contraceptive agents?

   Hint: See Clinical Presentation and Diagnosis in PPP

FOLLOW-UP

Patient presents 4 weeks later. How is your ankle pain? How is your contraceptive working for you?

Hint: See Chapter 35 and Outcome Evaluation in PPP

CASE SUMMARY

Global Perspective

Unintended pregnancy continues throughout the world. From 2015 to 2019, approximately 121 million unintended pregnancies occurred each year globally. Of these, 61% resulted in abortion. Overall, compared to 1990 to 1994, unintended pregnancies have decreased from 79 to 64 per 1,000 women ages 15-49 years, however abortion has increased from 51% to 61%. Contraceptive access and proper use are very important particularly in lower income countries where unintended pregnancy is higher compared to middle and high-income countries.

Key References