Hormonal Contraceptives in Women - Case Study Example

Hormonal Contraceptives in Women There are three case studies which are to be examined here: that of a 17-year-old, a 39-year-old, and a 46-year-old--each in varying stages of health; each with a current status as a smoker or non-smoker; each at a various stage in her sex life; and each at a different phase of threshold of using contraceptives in some way, shape or form. Individualized choices have been made and recommended regarding contraception plans for each woman--based on her health, smoking status, and sex life. Following each choice will be a rationale for each decision as to why which type of contraception was chosen for that patient over another. The first case we have is of a seventeen-year-old who is healthy, but smokes 5 to 10 cigarettes per day. She has been sexually active for eight months, and has had several sexual partners. The recommendation is that this patient have monthly injections of Lunelle as her contraceptive. There are several reasons for this. First of all, “Epidemiologic and case-control studies from the past 40 years have produced inconsistent evidence as to whether oral contra- ceptives increase the risk of MI [myocardial infarction, or heart attack] in women who smoke.” (American Academy of Family Physicians, 2007, pp. 1, pgh. 8.) It’s not highly likely that a seventeen-year-old will have a heart attack from smoking 10 cigarettes a day, but anything is possible, and in the arena of health, it is probably best to err on the side of caution, if anything. Nevertheless, Lunelle would probably be the best way to go instead of just breaking down and automatically starting the teenager on oral contraceptive pills, which have many benefits—but generally would seem to be a quick fix by just prescribing them to this young girl. The Lunelle would be efficient in that it would require her to come in for an injection and be monitored every month. 0 0 1 Thus, Lunelle would be a good choice for the 17-year-old because it is not the tempting quick-fix solution that an oral contraceptive would have—as the oral contraceptive might appeal to the youngster that all one has to do is just pop a pill and be done with the matter of preventing pregnancy. However, Lunelle will indeed force the youngster to deal with something unpleasant once a month (a shot), but for a woman it could be likened unto getting one’s menses once a month; it is a nuisance, but in the end it is only once a month. Plus, the young lady gets to keep her fast-paced lifestyle. Most importantly, she won’t have to change her sexual habits or worry about other devices, such as IUD’s or vaginal rings coming undone. Especially with all of the potential side effects and problems that could come along with an IUD being inserted into the vagina, it probably makes better sense just to get a Lunelle injection. Even Transdermal patches sound like a nuisance, as something you have to monitor (i.e., taking them on and off at certain times). And then, what if the patch falls off? The Lunelle injection, for the 17-year-old, is the best bet. In the second case, the patient is a 39-year-old woman who is married. She smokes two packs of cigarettes per day. She has been on oral contraceptives for 10 years without problems and desires a prescription refill. She does not desire any more children. For this particular patient, the recommendation is to switch her to an injection of Depo-Provera every three months. The reasoning for this is multi-purposed: First of all, being a smoker, the patient is at risk for either having or developing high blood pressure or hypertension problems. “Studies have shown that the use of oral contraceptives (including newer agents) increases blood pressure by as much as 8 mm Hg systolic and 6 mm Hg diastolic. However, depot medroxyprogesterone acetate (DMPA; Depo-Provera) does not significantly affect blood pressure.” (American Academy of Family Physicians, 2007, pp. 1, pgh. 3.) Secondly, the other reason that is a particularly pressing matter is the fact that, since this woman is over the age of 35, her risks of having a heart attack or mitigating circumstances surrounding the heart greatly increase if she continues taking oral contraceptives: “Some studies have reported increases in the risk of vascular events in women taking combination estrogen/progestin contraceptives.” (American Academy of Family Physicians, 2007, pp. 1, pgh. 3.) Thirdly, there is a very real concern of women possibly developing type 2 diabetes; therefore, “because of theoretical concerns, ACOG [the American College of Obstetricians and Gynecologists] recommends that the use of combination oral contraceptives be limited to nonsmoking, otherwise healthy women with diabetes who are younger than 35 years and show no evidence of hypertension, nephropathy, retinopathy, or other vascular disease.” (American Academy of Family Physicians, 2007, pp. 1, pgh. 7.) Clearly, the American College of Obstetricians and Gynecologists recommends the use of oral contraceptives be limited to nonsmoking women, generally healthy, and are younger than 35 years old. For the second case it is most obvious that this woman should go on Depo-Provera since it will be less of an interference on her lifestyle than, would, say, Lunelle (for which she would have to go in to the doctor every month for a shot). So she could keep her hectic married lifestyle on-track and not have to do much maintenance in that regard, but still guard herself from the possible ills of oral contraceptives for a woman who is a smoker as she is, at her age. For the third and final case study, the patient to be analyzed is a 46-year-old woman who is divorced. She has had several sexual partners in the past six months. She is a non-smoker in good health, and she has been on oral contraceptives for 18 years without problems. It seems that the most minimally invasive recommendation for this woman’s contraceptive plan is to allow her to continue on with oral contraceptives. “The action of oral contraceptives is to prevent ovulation while permitting regular recurrence of uterine bleeding. This method at present requires a preliminary period of regulation and the careful practice of the female, who must remember to take the pills at specified periods of time.” (Freeman, 1970, 228) According to the American Academy of Family Physicians, since this woman is over age 35, such a plan to allow her to continue taking oral contraceptives may even be beneficial to her. In Armstrong’s article (2007), the use of oral contraceptives is safe in healthy, nonsmoking women older than 35 years and may have a beneficial effect on bone mineral density in perimenopausal women—as well as having the effect of possibly reducing the risk of certain cancers to which women of older reproductive age are prone. Clearly, this passage indicates that since this woman is a non-smoker, is in good health, and is older than 35, oral contraceptives could in effect help prevent osteoporosis—which is something that she should be concerned about at this age. Additionally, the use of the contraceptive lowers her risk of cancers, which should also be another important issue to her. Having taken all of these things into consideration, it would probably be best to allow her to continue with the oral contraceptives. These three case studies have been analyzed in some detail. Their contraceptive recommendations were respectively based on the information given. Each case study was afforded a rationale for the choice of contraceptive with which they would be provided, given the nature of each patient’s circumstances. REFERENCES American Pregnancy Association. (2006). Lunelle: Monthly Injection. Retrieved October 7, 2008, from Promoting Reproductive and Pregnancy Wellness Web Site: http://www.americanpregnancy.org/preventingpregnancy/lunelle.html. Armstrong, Carrie. (2007). Practice Guidelines: ACOG Releases Guidelines on Hormonal Contraceptives in Women with Coexisting Medical Conditions. Retrieved October 7, 2008, from The American Academy of Family Physicians Web Site: http://www.aafp.org/afp/20070415/practice.html#p1. Family Planning: Educational Counseling and Method Selection. (2008). PowerPoint Presentation. Freeman, Ruth. (1970). Community Health Nursing Practice. London: W.B. Saunders Company. Read More