Case:Karen, is a 33 year-old G2P2, with a medical history …

Case: Karen, is a 33 year-old G2P2, with a medical history of migraines, for which she takes Imitrex when needed. She has a history of heavy and painful menses each month, lasting approximately 7-8 days. Karen smokes ½ pack of cigarettes per day. Her father has a history of DVT and cardiac disease. Her mother has a history of cervical cancer. Her blood pressure today is 138/76 and her pelvic exam is normal. She is divorced and is sexually active with her new boyfriend. She is currently using condoms for birth control and wants something more reliable. Karen does not desire pregnancy in the near future.



This case presents the scenario of Karen, a 33-year-old woman with a medical history of migraines, heavy and painful menses, and a family history of cardiovascular disease and cervical cancer. Karen is currently sexually active and using condoms for birth control, but she desires a more reliable contraceptive method. This case highlights the importance of assessing Karen’s medical history, identifying risk factors, and considering her desires and preferences for choosing an appropriate contraceptive option.

Medical History:

Karen’s medical history includes migraines and heavy and painful menses. Migraines are a common neurological disorder characterized by recurring headaches that can be moderate to severe in intensity. It is essential to determine whether Karen’s migraines are with or without aura, as this information could influence the choice of contraceptive method. Combined hormonal contraceptives (CHCs), such as birth control pills, may increase the risk of stroke in women with migraines with aura. However, they are generally considered safe for women with migraines without aura. It would be prudent to gather additional information regarding Karen’s migraines to inform the decision-making process.

Gynecologic History:

Karen reports heavy and painful menses lasting approximately 7-8 days. These symptoms could indicate a condition called menorrhagia, which is characterized by abnormally heavy or prolonged menstrual bleeding. It may be necessary to explore potential underlying causes of menorrhagia, such as uterine fibroids, polyps, or hormonal imbalances. These underlying conditions could impact the choice of contraceptive method, as some contraceptives, such as hormonal intrauterine devices (IUDs), may help manage menorrhagia.

Family History:

Karen’s family history includes a father with a history of deep vein thrombosis (DVT) and cardiac disease, and a mother with a history of cervical cancer. These familial conditions raise concerns about potential inherited risk factors that may impact Karen’s health. DVT is a blood clot that forms in the deep veins of the legs, which can lead to serious complications, such as pulmonary embolism. Cardiac disease encompasses a wide range of conditions that affect the heart and blood vessels. Cervical cancer is a malignant tumor that develops in the cervix. It is essential to consider the implications of these family history findings and assess Karen’s individual risk for these conditions when choosing a contraceptive method.

Current Contraceptive Method:

Karen is currently using condoms for birth control, which provide protection against sexually transmitted infections (STIs) in addition to pregnancy prevention. However, she desires a more reliable contraceptive method. This suggests that Karen values both pregnancy prevention and STI protection. It is important to provide information about the effectiveness, risks, and benefits of different contraceptive options to help Karen make an informed decision based on her individual circumstances and preferences.

Desire for Future Pregnancy:

Karen states that she does not desire pregnancy in the near future. This information is crucial in selecting a contraceptive method that aligns with her reproductive goals. Some contraceptive methods, such as long-acting reversible contraceptives (LARCs) like IUDs and contraceptive implants, have high efficacy rates and are reversible, allowing for a relatively quick return to fertility once discontinued. Other methods, such as sterilization or permanent contraception, should be discussed if Karen does not desire pregnancy at all in the future.

Consideration for Potential Contraindications:

In addition to the information provided, it is essential to consider other potential contraindications or factors that may affect the choice of contraceptive method for Karen. These may include her smoking habit, blood pressure, and any other medical conditions or medications she may be taking. Smoking is associated with an increased risk of cardiovascular events and certain adverse effects of hormonal contraceptives. Elevated blood pressure may also influence the choice of contraceptive method, as some methods may be contraindicated in individuals with poorly controlled hypertension.


The case of Karen emphasizes the importance of comprehensive assessment and individualized counseling when choosing a contraceptive method. By considering her medical history, gynecologic symptoms, family history, current contraceptive method, desire for future pregnancy, and potential contraindications, healthcare providers can assist Karen in making an informed decision about the most appropriate and effective contraceptive option that aligns with her preferences and reproductive goals.