Contraceptive Options and Evidence-Based Prescription

It is evident that the contemporary healthcare system offers a considerably wide variety of contraceptive methods. As it is mentioned by Woo and Robinson (2016), current contraceptive options include various pills, patches, rings with the combination of progestin and estrogen or progestin-only; also there are various intrauterine devices as well as barrier methods. In the case study under discussion, Margaret, a 40-year-old white female, comes for the annual examination. The purpose of this paper is to provide an evidence-based decision on which contraceptive option should be prescribed for Margaret.

First of all, it is of high significance to determine the appropriate method of contraception for the patient. Barrier contraceptive options are not considered because Margaret claims that she does not have a new partner since she and her husband split up. It is possible to mention that options including the use of estrogen-based medications or devices are contraindicated for the patient. According to Woo and Robinson (2016), there is a classification that determines whether or not a patient should be prescribed estrogen-based options. From the information provided by Margaret during the examination, it is known that she is 40 years old and smokes approximately a pack of cigarettes a day. As per the classification provided by Woo and Robinson (2016), patients who are older than 35 years and smoke more than 15 cigarettes a day are within the WHO Category 4, which indicates the unacceptable risk of prescribing estrogen-based contraceptive options. Therefore, it is evident that Margaret should be prescribed either progestin-only or intrauterine contraceptive option.

In order to consider which particular method should be chosen from the available set of options, it is essential to consider other aspects of the information provided by the patient. Firstly, the patient mentions that she used pills because it controlled her menstrual cycle. Secondly, she also states that as her husband left, she has to work a lot along with caring for her teenage children. Thirdly, as it was mentioned earlier, she does not have a sexual partner at the moment. Therefore, it appears to be that two most appropriate options for Margaret are copper or progestin-releasing intrauterine devices (IUD) (Woo & Robinson, 2016). Copper IUD offers contraception for 10 years and it is hormone-free, but it might increase the menstrual flow in the first several months after the insertion (Woo & Robinson, 2016). Progestin-releasing IUD provides contraception for 3 or 5 years, it only contains progestin, and, most importantly, it helps to decrease the menstrual flow (Woo & Robinson, 2016). The study by Heinemann, Reed, Moehner, and Do Minh (2015) confirms the efficiency of the chosen options.

It is important to mention that the patient has a considerably normal level of education in terms of contraception due to the fact that she noticed herself that smoking might be harming in the combination with pills. Additionally, she knows how to self-examine breasts, which is another important aspect of self-health education. Finally, it is worth mentioning that during the examination it was found that the patient has a normal pelvic exam. This fact positively influences the decision about prescribing an intrauterine contraceptive option because the patient does not have any physical contraindications for it. Since the use of intrauterine devices requires the process of insertion as well as bearing the inserted device for several years, it is important that the patient’s pelvic exam did not indicate any troubles that might cause complications in the future.

References

Heinemann, K., Reed, S., Moehner, S., & Do Minh, T. (2015). Comparative contraceptive effectiveness of levonorgestrel-releasing and copper intrauterine devices: The European active surveillance study for intrauterine devices. Contraception, 91(4), 280-283.

Woo, T. M., & Robinson, M. V. (2016). Pharmacotherapeutics for advanced practice nurse prescribers (4th ed.). Philadelphia, PA: F. A. Davis Company.