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,
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.
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