Case Scenario 1:

Complete the chart and answer the case scenario.

Birth How it % of Combined Contraindicated
Control works/ effectiveness contraception for patients with/
frequency of perfect use VS Progestin- who are
usage VS typical only method
use
Pill The pill It is 99% Progestin-only Both are
reduces effective contains contraindicated
ovulation when taken progestin, in patients with
and causes perfectly and while ischemic heart
the cervical 91% effective combined disease,
mucus to when contraception hypertension,
thicken, typically has both those aged above
blocking the used. estrogen and 35 years, and
sperm. The progestin. individuals
lining of the Non-lactating smoking 15
endometrium women, one cigarettes daily.
becomes pill to stop Breastfeeding
thin, thus ovulation and mothers should
inhibiting progestin-only not take
implantation. to thicken the combined
Pills are cervical contraception for
taken daily mucus. the first six
for three months.
weeks in a
regular
monthly
cycle.
Patch It releases It is 99% A progestin Progestin-only is
estrogen into effective and patch produces contraindicated
the blood, 92% effective only in breast cancer,
preventing when used progesterone suspected
ovulation incorrectly. through the pregnancy, and
and skin into the vaginal bleeding.
thickening bloodstream, Combined
the cervical while a patches should
mucus. combined one not be used by
releases both mothers with
progestin and hypertension,
estrogen smoking
through the mothers, mothers
skin into the less than six
bloodstream. weeks
postpartum, of
 age more than 35
years and
pregnant women.
NuvaRing It functions It is 99% NuvaRing's It is
primarily by effective and combined contraindicated
preventing 93% when hormone in women with
ovulation incorrectly releases uncontrolled
and causing used. progesterone hypertension,
the cervical and estrogen DVT, smoking,
mucus to hormones into blood clots,
thicken to the vascular disease,
prevent the bloodstream, and more than 35
penetration while years.
of the sperm. progestin-only
releases only
progesterone.
It is safe for
lactating
mothers.
Annovera It is placed Annovera is It is a Annovera is
in the vagina 97.3% combined ring contraindicated
to release effective with both in women with
hormones when used progesterone acute hepatitis,
that inhibit correctly. and estrogen those at risk of
ovulation, hormones. arterial
changing the thrombotic and
uterus lining venous disease,
and and those with a
preventing history of breast
implantation. cancer and liver
tumours.
DMPA It is an It is 99% DMPA It is prohibited in
injection effective injection suspected
with when contains pregnancy,
progestin- correctly used progesterone history of stroke,
only that and adherence only. diabetes, current
thickens the to injection thrombophlebitis,
cervical after every hypertension,
mucus and three months dyslipidemia,
prevents and 94% and obesity.
ovulation, effective
hence when
preventing incorrectly
the sperm used.
from
penetrating.
 Implant It produces When Implanon and It is
hormones to inserted well, Jadelle contraindicated
thicken the implants are implants are in suspected
cervical 99% progestin-only pregnancy,
mucus and effective. and release hypersensitivity,
inhibit progesterone breast cancer,
ovulation, into the undiagnosed
preventing bloodstream. vaginal bleeding,
the and liver disease.
penetration
of the sperm
from
reaching the
ovum.
Paragard Paragard Once in place, It releases It is
releases it has more copper ions contraindicated
copper ions than 99% and is in non- in fibroids, pelvic
into the effectiveness. hormonal infection,
fallopian form. cervical or
tubes and uterine cancer,
uterine uterine
cavity. The abnormalities,
ions destroy and undiagnosed
the sperm, vaginal bleeding.
inhibiting
fertilization.
LNG IUD It works by When placed It is a It is
thickening correctly, it is progesterone- contraindicated
the cervical 99% only IUD. in abnormal pap
mucus, effective. smear, suspected
preventing pregnancy,
the cervical
movement of neoplasia, uterine
the sperm anomaly, and
into the endometritis.
cervix.
Denise, a 19-year-old female, presents to the clinic for an annual physical exam. She is G0P0
and presents with irregular menses only occurring every 3-4 months apart within the past two
years. She is sexually active and only uses condoms occasionally. She is not on any other birth
control methods. She denies any significant medical or surgical health history or other health
problems. She has never had a Pap smear or pelvic exam test before today. Her pregnancy test is
negative, and her vital signs are all WNL.
Write a brief SOAP note regarding this patient. Make sure to include your answers to these
questions in your SOAP note.
1. Subjective:
a. What other relevant questions should you ask regarding the HPI?
 How many sanitary pads does she use daily, and what is the frequency of the
menstruation?
 What were the characteristics of her menses and heaviness before the changes?
 At what age was her menarche?
 What is the intensity of the cramps during menstruation?
 Is the colour of her menses clots or fresh blood?
b. What other medical history questions should you ask?
 Is there any history of invasive gynaecological surgery, PID, and endometriosis?
 Is there any drug that might have interfered with the menses?
 Is there any other medical condition?
c. What other social history questions should you ask?
 Is there any similar history in the family?
 Does your friends or family support you?
 How many sexual partners do you have?
 Do you use drugs or smoke?
 Do you have depression or stress?
Objective:
d. What point of care testing (POCT) would you perform or order for this patient?
 Blood test for DHEA, Pap smear, rectal-vaginal exam, TSH, FSH, pelvic ultrasound,
cortisol, hysteroscopy, cervical swab, and prolactin.
e. The patient states she has not had a pap smear. Is it appropriate to perform a pap on this
patient? Why or Why not?
 It is appropriate for a Pap smear to be performed on the patient to check the presence of
abnormal cells in the cervix because she has missed her periods for more than three months.
2. Assessment/ Diagnosis:
a. What would be an appropriate diagnosis for her? Why?
 Secondary Oligomenorrhea. Though infrequent, it can cause the cycle to take more than
35 days.
b. Is there any other diagnosis or differential diagnosis you would like to add?
 Pelvic inflammatory disease
 Polycystic ovarian syndrome
 Androgen secreting tumor
 Primary ovarian insufficiency
3. Plan:
a. What will you prescribe for this patient? Why?
 Ibuprofen to relieve painful menstrual cramps.
 Norethindrone to treat endometriosis and abnormal periods.
b. What patient education is important to include for this patient?
 Educate the patient on the significance of visiting a gynaecologist for pap smears and
check-ups regularly.
 Educate the patient to use protection when having sex to prevent STDs.
 Educate the patient on the importance of contact tracing, drug adherence, and follow-up
in case of an STD.
 Educate the patient on the necessary tests, exams, and the possible causes of abnormal
irregular periods.
 Educate the patient on the family planning methods to prevent pregnancy.