Birth Control
How it works/ frequency of usage
% of effectiveness perfect use VS  typical use
Combined contraception VS Progestin-only method
Contraindicated for patients with/ who are
Pill
The pill reduces ovulation and causes the cervical mucus to thicken, blocking the sperm. The lining of the endometrium becomes thin, thus inhibiting implantation.
Pills are taken daily for three weeks in a regular monthly cycle.
It is 99% effective when taken perfectly and 91% effective when typically used.

Progestin-only contains progestin, while combined contraception has both estrogen and progestin.
Non-lactating women, one pill to stop ovulation and progestin-only to thicken the cervical mucus.

Both are contraindicated in patients with ischemic heart disease, hypertension, those aged above 35 years, and individuals smoking 15 cigarettes daily.
Breastfeeding mothers should not take combined contraception for the first six months. 
Patch
It releases estrogen into the blood, preventing ovulation and thickening the cervical mucus.

It is 99% effective and 92% effective when used incorrectly.

A progestin patch produces only progesterone through the skin into the bloodstream, while a combined one releases both progestin and estrogen through the skin into the bloodstream.

Progestin-only is contraindicated in breast cancer, suspected pregnancy, and vaginal bleeding. Combined patches should not be used by mothers with hypertension, smoking mothers, mothers less than six weeks postpartum, of age more than 35 years, and pregnant women.
NuvaRing
It functions primarily by preventing ovulation and causing the cervical mucus to thicken to prevent the penetration of the sperm.

It is 99% effective and 93% when incorrectly used.

NuvaRing’s combined hormone releases progesterone and estrogen hormones into the bloodstream, while progestin-only releases only progesterone.
It is safe for lactating mothers.
It is contraindicated in women with uncontrolled hypertension, DVT, smoking, blood clots, vascular disease, and more than 35 years.

Annovera
It is placed in the vagina to release hormones that inhibit ovulation, changing the uterus lining and preventing implantation.
Annovera is 97.3% effective when used correctly.

It is a combined ring with both progesterone and estrogen hormones.

Annovera is contraindicated in women with acute hepatitis, those at risk of arterial thrombotic and venous disease, and those with a history of breast cancer and liver tumors.
DMPA
It is an injection with progestin-only that thickens the cervical mucus and prevents ovulation, hence preventing the sperm from penetrating.
It is 99% effective when correctly used and adherence to injection after every three months and 94% effective when incorrectly used.
DMPA injection contains progesterone only.

It is prohibited in suspected pregnancy, history of stroke, diabetes, current thrombophlebitis, hypertension, dyslipidemia, and obesity.
Implant
It produces hormones to thicken the cervical mucus and inhibit ovulation, preventing the penetration of the sperm from reaching the ovum.
When inserted well, implants are 99% effective.
Implanon and Jadelle implants are progestin-only and release progesterone into the bloodstream.
It is contraindicated in suspected pregnancy, hypersensitivity, breast cancer, undiagnosed vaginal bleeding, and liver disease.

Paragard
Paragard releases copper ions into the fallopian tubes and uterine cavity. The ions destroy the sperm, inhibiting fertilization.
Once in place, it has more than 99% effectiveness.

It releases copper ions and is in non-hormonal form.

It is contraindicated in fibroids, pelvic infection, cervical or uterine cancer, uterine abnormalities, and undiagnosed vaginal bleeding.
LNG IUD
It works by thickening the cervical mucus, preventing the movement of the sperm into the cervix.
When placed correctly, it is 99% effective.

It is a progesterone-only IUD.

It is contraindicated in abnormal pap smear, suspected pregnancy, cervical neoplasia, uterine anomaly, and endometritis.

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.
Subjective:
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 color of her menses clots or fresh blood?
What other medical history questions should you ask?
Is there any history of invasive gynecological surgery, PID, and endometriosis?
Is there any drug that might have interfered with the menses?
Is there any other medical condition?
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:
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.
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.
Assessment/ Diagnosis:
What would be an appropriate diagnosis for her? Why?
Secondary Oligomenorrhea. Though infrequent, it can cause the cycle to take more than 35 days.
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
Plan:
What will you prescribe for this patient? Why?
Ibuprofen to relieve painful menstrual cramps.
Norethindrone to treat endometriosis and abnormal periods.
What patient education is important to include for this patient?
Educate the patient on the significance of visiting a gynecologist 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.