Reply to my peers

Peer 2

Discussion 1:

1. What options are appropriate for this patient?

Margaret is a 40-year-old female that is under increases stress and a smoker. Margaret meets criteria to take Progestin only pills, IUD, implant or injection (CDC, 2016). Prior to starting any hormonal contraceptives, it is good practice to rule out pregnancy (Woo et al., 2020). 2. What contraceptive options are contraindicated?

Although Venous Thromboembolism (VTE) occurrence while taking oral Contraceptive is low, her age and smoking history places her in higher risk. Risk factors such as inherited clotting disorders, strong family history of inherited clotting disorders, being older than 35 years, smoking more than 10 cigarettes per day, or obesity increase the risk 3 to 10 times (Woo et al., 2020). According to the CDC 2016, a female older than 35 years old that smokes more than 15 cigarettes a day is a category 4 (Unacceptable health risk, method not to be used) for CHC (Combined Hormonal Contraceptives; pill, patch or ring) (CDC, 2016). 3. What type of patient education is indicated?

Smoking cessation is key for any patient, along with education on the contraceptives she meets criteria for do not prevention STI’s. F/u between 3 to 6 months if IUD is pt’s contraceptive choice. Breakthrough bleeding frequently occurs in the initial cycle of use of any Progestin only contraceptive (Woo et al., 2020). Injection (Depo) is taken every 12 weeks with very reliable efficacy. Women should not take Depo longer than 2 years consecutively due to loss of bone mineral density (Woo et al., 2020). 4. Given that she has a normal pelvic exam, does that change would that influence your decision?

A normal pelvic exam is important. If Margaret had a hx of PID (Pelvic inflammatory disease) she would not meet criteria for any IUD placement due to risk for STI’s. This is not in her history, there are no changes in what contraceptives she is eligible for. 

Reference:

National Center for Chronic Disease Prevention and Health Promotion. (2016). Summary chart of U.S. medical eligibility criteria for ... CDC. Retrieved October 10, 2021, from https://www.cdc.gov/reproductivehealth/contraception/pdf/summary-chart-us-medical-eligibility-criteria_508tagged.pdf. 

Woo, T. M., Wynne, A. L., & Robinson, M. V. (2020). Pharmacotherapeutics for Advanced        Practice Nurse prescribers. F.A. Davis Company.