J.L., a 27-year-old account executive, presents to the family medicine office for her annual checkup with her primary care provider. She has no significant past medical history except heavy menses. Her medications include calcium carbonate 500 mg orally twice a day and a multivitamin daily. She exercises regularly. Her family history is significant for cardiovascular disease (her father had an MI at age 54 and died of a further MI at age 63). She notes that she has been dating her current partner for approximately 5 months. She is interested in a reliable form of contraception. After discussing the various contraceptive options, she is here for contraceptive counseling. 1. Before prescribing an OCP regimen, what tests or examinations would you like to perform? 2. Identify three different contraceptive regimens that could be chosen for J.L. Note their differences and why you chose them. 3. Identify the potential side effects that need to be relayed to J.L. Note especially those side effects for which J.L. should seek immediate medical care. Respond in complete sentences, 2-3 paragraphs. Work must be supported by peer-reviewed article published within 5 years. Purchase the answer to view it Purchase the answer to view it

1. Before prescribing an oral contraceptive pill (OCP) regimen, it is important to perform certain tests and examinations to ensure the safety and efficacy of the chosen method. These tests/examinations may include a medical history review, physical examination, blood pressure measurement, and laboratory tests.

Firstly, a thorough medical history review is necessary to identify any contraindications or risk factors that may affect the choice of contraceptive method. In the case of J.L., her family history of cardiovascular disease is significant, as it may increase her risk for certain hormonal contraceptives, such as those containing estrogen. Additionally, her history of heavy menses may suggest an underlying condition, such as a bleeding disorder, which should be evaluated further before starting hormonal contraception.

Next, a physical examination should be conducted to assess J.L.’s general health and identify any potential contraindications. This examination may include measurements of height, weight, and body mass index (BMI), as well as an assessment of her cardiovascular and reproductive systems. This can help determine if J.L. has any contraindications to using certain contraceptive methods, such as those related to obesity or cardiovascular conditions.

Measurement of blood pressure is crucial, as certain hormonal contraceptives can increase blood pressure, thereby increasing the risk of cardiovascular events. It is important to ensure that J.L. does not have an elevated blood pressure that would contraindicate the use of estrogen-containing contraceptives.

Finally, laboratory tests may be necessary to assess baseline health parameters and rule out specific conditions. In the case of J.L., it would be important to evaluate her lipid profile to assess her cardiovascular risk. Additionally, a complete blood count (CBC) and coagulation studies may be considered to evaluate her heavy menses and rule out any bleeding disorders.

2. There are several different contraceptive regimens that could be chosen for J.L., depending on her preferences and medical considerations. Three potential options include combined oral contraceptives (COCs), progestin-only pills (POPs), and the contraceptive patch.

COCs contain both estrogen and progestin and are usually taken for 21 days, followed by a 7-day pill-free interval. They are highly effective in preventing pregnancy when taken correctly. The main difference between COCs is the type and dose of hormones used. For J.L., it may be prudent to choose a COC with a lower estrogen dose or a different progestin to minimize her cardiovascular risk. This can be achieved by selecting a COC with a lower overall dose of estrogen, such as a “low-dose” or “ultra-low-dose” formulation. Alternatively, a COC containing a different progestin, such as drospirenone, may be considered, as it has been shown to have a lower risk of venous thromboembolism compared to other progestins.

POPs, on the other hand, contain only progestin and are taken daily without a pill-free interval. They are a good option for women who are unable to take estrogen or have contraindications to its use. POPs may be suitable for J.L. if she has concerns or contraindications related to estrogen use, such as her family history of cardiovascular disease. However, it is important to note that POPs require strict adherence to daily dosing as they have a narrower window of efficacy compared to COCs.

The contraceptive patch is another option that can be considered. It delivers both estrogen and progestin through the skin and is applied once a week for three weeks, followed by a patch-free week. The patch offers similar efficacy to COCs but may be preferred by some women who find it easier to use than daily pill-taking. It is important to consider the potential for skin irritation or allergic reactions when choosing the patch, and this should be discussed with J.L. during counseling.

3. When discussing potential side effects with J.L., it is important to highlight both common and rare but serious side effects. Common side effects of hormonal contraceptives include breakthrough bleeding, breast tenderness, headache, and nausea. These side effects are usually temporary and tend to resolve within a few months of starting the method.