1. What options are appropriate for this patient?
When it comes to the decision on which contraceptive works best for a patient, a physician should consider family and personal health history, lifestyle, and all aspects of health (Bartlik et al., 2018). Margaret has been under a lot of stress due to separation and the thought of divorce. She resorted to smoking and unhealthy eating habits. She also has a family history of diabetes and cardiovascular diseases. From the above assessment, Margaret should avoid hormonal birth control pills, and the available contraceptive options are Depo-Provera since it has progestin hormone only and barrier methods, which include cervical cap, condom, spermicides, and diaphragm (Bartlik et al., 2018). Smoking while on hormonal birth control pills increases the chances of stroke, heart attack, or blood clots (Allen et al., 2018).
2. What contraceptive options are contraindicated?
Contraindicated contraceptives options for Margaret are oral contraceptives. Margaret is 40 years, and she smokes, and women who smoke and are above 35 years old have a high chance of heart attack and stroke if they use pills. Smoking increases the risk of cardiovascular side effects from the use of pills ( Allen et al., 2018). Oral contraceptive pills can also worsen cardiovascular risk factors, which include diabetes and hypertension, which are present in her family history. 3. What type of patient education is indicated?
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The type of education indicated is Smoking cessation intervention, a healthy lifestyle, and suitable contraceptive for smokers. Smoking cessation is the process of quitting cigarette smoking (Allen et al., 2018). Margaret has been smoking and, at the same using contraceptive pills. Smoking increases the chances of cardiovascular events, and that’s why people should be encouraged to quit smoking. Margaret started unhealthy eating habits, which made her overweight. The implementation of physical exercises will reduce weight and BMI. Smokers should not use any hormonal contraceptives since it will increase the chances of a cardiovascular event (Bartlik et al., 2018).
4. Given that she has a normal pelvic exam, does that change would that influence your decision?
With a normal pelvic exam, my decision on the available contraceptive options for Margaret will not change. Apart from normal pelvic organs, Margaret still has a family history of diabetes, and she is a smoker. Therefore any hormonal contraceptive is contraindicated for Margaret because of the risks of cardiovascular events.
References
Allen, A. M., Carlson, S., Eberly, L. E., Hatsukami, D., & Piper, M. E. (2018). Use of hormonal contraceptives and smoking cessation: A preliminary report. Addictive Behaviors , 76 , 236-242. https://doi.org/10.1016/j.addbeh.2017.08.003
Bartlik, B., Kaur, A., Schoen, C., & Kolzet, J. (2018). Birth Control Pills and Hormonal Contraception (DRAFT). Oxford Medicine Online . https://doi.org/10.1093/med/9780190225889.003.0009
