Case study: Scenario 2
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
- HEENT:? wnl
- Neck: supple without adenopathy
- Lungs/CV: wnl
- 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
Respond to posts below and explain how you might think differently about the types of tests you might recommend and explain why or if you agree with his post.In this case, I agree that the best contraceptive method for the patient will be Copper IUD.
After reviewing Ms. Goodwin’s medical history, the items that required attention regarding her pursuance of contraception were a positive history exercise-induced asthma,?seizures, and use of?Lamictal (lamotrigine). These factors will all be considered when selecting the proper form of contraception for Ms. Goodwin.
Combined oral hormonal contraceptive (COC) pills are the most used contraception in the United States, but the risks are relatively higher than other contraceptive methods and there are contraindications in certain medical conditions (Fox, Hai & Mervyn-Cohen, 2016). Asthma has mixed reviews when using COC, stating that use of contraceptives is associated with impaired lung function and is a risk factor for development or exacerbation of asthma crises (de Carvalho Baldacara & Silva, 2017). While others reported that estrogen and progesterone improve total lung capacity and reduce the exacerbation of asthma symptoms, such as coughing, wheezing and dyspnea (de Carvalho Baldacara & Silva, 2017). When COCs are used in patients taking lamotrigine for seizure activity, it was discovered that COCs can reduce lamotrigine serum concentrations by approximately 60%, which may lead to loss of seizure control in patients (Reimers, 2019). This happens because ethinyl estradiol, a component of COCs, can affect the metabolism of many other drugs such as lamotrigine which is mainly metabolized by UGT1A4, an enzyme that is induced by ethinyl estradiol (Reimers, 2019).
Given these risks, the choice of contraception offered to Ms. Goodwin would be the copper intrauterine device (IUD). This type of contraception is a non-hormonal option, 99% effective, reversible and can last 10-12 years (Fox, et al, 2016). Should she accept this form of contraception, she should be made aware that it is available in office for same day insertion, requires no preparation by the patient, and takes 10-15 minutes to insert (Fox, et al, 2016). Education on the copper IUD should include information that it may cause heavier periods with more cramping, which may improve after 6 months and can be easily treated with NSAIDs and heating packs (Fox, et al, 2016).