Response # 1 to Casey Case Study # 3
Case Study 3
A 33-year-old Caucasian female is being seen in clinic for contraception. She is using birth control pills, but forgets to take them because her work schedule changes
every week. She has been married for 14 years and has two children. She is looking for an effective method that will be easy to remember. She has a history of chronic
headaches and hypertension during pregnancy. She has never been treated for a sexually transmitted infection (STI) and is in a mutually monogamous relationship. Family
history is significant for an aunt with breast cancer. She smokes half a pack of cigarettes per day. She is 5 ft. 8 in. and 215 lbs. Her vital signs are: BP 120/78, p
A contraception method that is appropriate for this patient is progestin-only contraceptives. This patient has cardiovascular risk factors, such as smoking
half a pack of cigarettes per day and obesity. Progestin-contraception methods have minimal effects on blood pressure and is considered safer for women who have
contraindications to estrogen, such as cardiovascular risk factors and migraines (Schuiling & Likis, 2017). Progestin-only contraception offers effective protection
against unintended pregnancy and minimal risk to women with medical conditions (Dragoman, Davis, & Banks, 2010). The types of progestin-only contraception include
pills, different types of intrauterine devices (IUDs), an injection, and an implant (Schuiling & Likis, 2017). Contraceptive injections, implants, and IUDs offer
long-acting protection for women that are not candidates for estrogen-containing contraceptives (Tharpe, Farley, & Jordan, 2013). This patient may also benefit from
long-acting contraception because she has trouble remembering to take her current birth control pills.
Discussing Contraception Recommendations
Contraception selection is a highly induvial decision that must meet the patient’s needs and provide safe protection. This patient has a range of
contraception options, even though she has risk factors that could limit her recommended choices. A patient may not agree with the recommendations made by the
clinician. If this patient does not agree with the recommendation of using progestin-only contraception, the clinician will need to work with the patient to develop a
plan that meets her needs. If the patient wants to take an estrogen-containing contraception, the provider will need to stress the importance of smoking cessation and
weight loss to reduce cardiovascular risks. Another option for this patient may be permanent contraception if she is sure that she does not want to have any more
children. A clinician’s role is to provide education and guidance that will allow the patient to select the best contraception option that meets her needs (Schuiling &
Dragoman, M., Davis, A., & Banks, E. (2010). Contraceptive options for women with preexisting medical conditions. Journal of Women’s Health, 19(3), 575–580.
Schuiling, K. D., & Likis, F. E. (2017). Women’s gynecologic health (3rd ed.). Burlington, MA: Jones and Bartlett Publishers.
Tharpe, N. L., Farley, C., & Jordan, R. G. (2013). Clinical practice guidelines for midwifery & Women’s health(4th ed.). Burlington, MA: Jones & Bartlett Publishers.
Response # 2 to Erica Case Study # 1
The menstrual cycle is a normal process, with approximately 10% of women with complaints of severe symptoms associated with their menstrual cycle (Schuiling & Likis,
2013). Those with premenstrual symptoms, experience pain, fatigue, mood swings, and physical discomfort. Premenstrual syndrome (PMS) can be defined as reoccurring
behavioral, somatic, and mood symptoms that impair a woman’s social and work-related functions (Schuiling & Likis, 2013).
A 23-year-old Caucasian female presents with concerns about mood swings around the time of her menses. She believes she has PMS and wants to know if there is
medication to control it.
Schuiling and Likis (2013) stated successful management of PMS “begins with the assessment of symptom clusters, symptom severity patterns, and their
degree of impact on a woman’s functional status”. In order to properly treat her, I would look for a pattern of symptoms lasting 3 days prior to her menses, that end
with 4 days after her menstrual flow, and that occur for at least 3 consecutive months (Schuiling & Likis, 2013). In addition to discussing symptoms, I would have her
complete a daily record of severity of problems as well as complete a brief patient health questionnaire.
SSRIs are the drug of choice for severe PMS because of their efficacy and tolerability (Steiner et al, 2006). They have been proven to improve
irritability, depression, psychosocial function, and physical symptoms. Due to the rapid onset of effect, women have a decrease reduction in symptoms or resolution
during the first menstrual cycle (Steiner et al, 2006).
For those opposed to SSRI treatment, lifestyle modifications, dietary supplements, and alternative treatments are available. Lifestyle changes can begin while
completing symptom charts. Dietary changes during the premenstrual phase may provide some relief. For example, by reducing caffeine intake pre-menstrually may
alleviate irritability and tension (Steiner, et al, 2006). Other dietary changes include increasing carbohydrate intake which has been proven to improve mood,
carbohydrate craving, and memory (Steiner et al, 2006). If symptoms continue then pharmacotherapy should be considered (Steiner et al, 2006).
Schuiling, K. D., & Likis, F. E. (2013). Women’s gynecologic health (2nd ed.). Burlington, MA: Jones and Bartlett Publishers
Steiner, M., Pearlstein, T., Cohen, L., Endicott, J., Kornstein, S., Roberts, C., & … Yonkers, K. (2006). Expert guidelines for the treatment of severe PMS, PMDD,
and comorbidities: the role of SSRIs. Journal Of Women’s Health (15409996), 15(1), 57-69. doi:10.1089/jwh.2006.15.57