Pediatric Primary Care Case Studies (113 page)

• Emergency contraception

•   Progesterone only

   
Advantages:
No estrogen; reversible; amenorrhea or scanty bleeding after prolonged use; improvement in dysmenorrhea, menorrhagia, premenstrual dysphoric disorder (PMDD), premenstrual symptoms, and endometriosis symptoms; decreased risk of endometrial or ovarian cancer; decreased risk of PID; compatible with breastfeeding. Depo Provera–specific: highly effective, discreet and private, not linked to coitus, requires user to remember only four times a year.

   
Disadvantages:
Menstrual cycle irregularities; weight gain; depression; headaches; no protection against STIs. When taking progestin-only pills, they must be taken at almost the exact same time every day. Progestin-only pills are not as effective as combined oral contraceptive pills. Depo-Provera–specific: weight gain, prolonged return to fertility, adverse effect on lipids, decreased bone mineral density with prolonged use (Caufield, 2004; Raymond, 2007).

   Option for Jaime: The progestin-only pills need to be taken precisely on time. Being an adolescent, this might not be the best option, plus Jaime is looking for an effective means of birth control. Depo-Provera, in contrast, is very effective; however, with decreased calcium absorption at the time when the most bone mass is being laid down, and the recommendation of not being on this method for more than 2 years, this might not be the optimal method for Jaime.

•   Barrier methods/spermicides

   
Advantages:
Male participation, no prescription needed, very inexpensive, effective in preventing pregnancy if used correctly with every intercourse, minimal side effects, provides some STI protection, no hormones.

   
Disadvantages:
Reduces sensitivity, reduces spontaneity, male erection problems, lack of cooperation from the male, embarrassment about purchasing, not very effective with “typical use,” latex allergy, some methods (diaphragm) need professional fitting (Cates & Raymond, 2007; Caufield, 2004; Warner & Steiner, 2007).

   Option for Jaime: This is certainly an option for Jaime, along with another method. At the very least, she would need to use a condom with spermicide with every act of intercourse. Blair has been resistant to this at times. With whatever method Jaime chooses, she needs to use condoms in addition to help prevent STIs.

•   Intrauterine device (Paraguard and Mirena)

   
Advantages:
Highly effective, no user error, convenient, long-lasting (10 years for Paraguard, 5 years for Mirena), reversible, discreet, cost-effective with prolonged use, low incidence of side effects, independent of coitus.

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Paraguard:
Can remain in place for up to 10 years, nonhormonal, normal menstrual pattern continues.

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Mirena:
Can remain in place for up to 5 years, protective against endometrial cancer, reduces menstrual bleeding by 90%, 20% of users become amenorrheic, low incidence of progestin side effects.

   
Disadvantages:
Menstrual problems, discomfort with insertion, expulsion of the device, perforation of the uterus, requires office visit with trained professional, high initial cost, no protection against STIs.

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Paraguard:
Can cause heavier menses with more severe cramping, especially the first few cycles.

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Mirena:
Irregular bleeding, especially during the first 6 months (Grimes, 2007; Caufield, 2004).

   Option for Jaime: Although not necessary, most providers would prefer to place an IUD in someone who has previously borne a child because the uterus has been stretched. The Paraguard can cause increased bleeding and cramping. This is something that Jaime is already concerned with, so the Paraguard would not be recommended. The Mirena, which decreases bleeding, could possibly be an option, but the irregular bleeding early in use might be a deterrent.

•   Fertility awareness/natural family planning

   
Advantages:
No hormones, no side effects, enables a woman to understand her body’s cycles, promotes cooperation between partners, can also be used to achieve pregnancy or to identify fertility problems, only method approved by the Catholic church.