Contraceptive advice 24 year old woman 49k

Question 1

social hx

Answer 1

-are you married, single
-previous pregnancy
-hx of gyenacplogical/medical problems

Question 2

Contraindications

Answer 2

-DVT, active liver disease
-breast cancer
-abnormal bleeding
-BP normal
-migraine
-medications, (antiepileptic/anti tb)
-smoking

Question 3

examination findings

Answer 3

-bp
-pelvic and abdominal exam
-pap smear
-breast exam

Question 4

which pill to use

Answer 4

1.Microgynon 30(monophaisc oestrogen )
-low breakthrough bleed
-low failure rate
-less costly
2Acne
-use with antiandrogen cyproterone(diane35.estelle35)/drospirenone (yaz) - costly
3.breast tender
-decrease oestrogen/progesterone dose
3.irregular bleed, oligomenorrhoea
-use triphasic preperation

Question 5

advice how to take

Answer 5

1.followup in 3/12
-check bp
-look for breakthrough bleeding
2. breakthrough bleeding
3. Missed Pills
-if >24 hours take immediately even if it means taking two at the same time, use condome 7 days
-if < 7 active pills, emergency contraception
-if <7 pills left b4 placebo break, skip placebos and ct with active pills
4.if diarrhoes vomiting
-vomit <2 hrs pill take another pill
5. Common S/e
-breakthrough bleeding first three months
-sore breast 1st two cycles