Case of a Girl Seeking Birth Control
AB is a 17-year-old girl who has migraines with aura and presents for contraceptive management. Based on the US Medical Eligibility Criteria for Contraceptive Use, estrogen-containing contraceptives are contraindicated for AB due to an elevated risk of thrombosis given her diagnosis of migraines with aura. After determining which contraceptive methods are safe, comprehensive counseling should start with a discussion of the most effective contraceptive methods including intrauterine devices (IUDs) and subdermal contraceptive implants. AB elects to have an IUD placed which is inserted the same day given it is reasonably certain she is not pregnant and no sedation is required prior to IUD placement. The only mandatory examination needed prior to IUD placement is a bimanual examination and cervical inspection in accordance with the US Selected Practice Recommendations for Contraceptive Use. Finally, condom use at every sexual encounter is recommended to reduce the risk for sexually transmitted infections.
KeywordsContraceptive agents Female Long-acting reversible contraceptive Intrauterine device Contraceptive implant Adolescent health Reproductive health
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