Long-Acting Reversible Contraception in Young, Nulliparous Woman

Healthcare Reform and Women's Health Preventive Services: What is Now Cost-Free to the Patient?
Healthcare Reform and Women's Health Preventive Services: What is Now Cost-Free to the Patient?

Miss C, a nulliparous 23-year-old woman, arrives as a new patient for an annual exam. She is also requesting information about contraceptive options. She states that she's concerned that she would not be “a good pill taker” on a daily basis. Her periods are regular, not painful, and light. Miss C states that she does not want children for a “long time,” if ever.

HISTORY
PMH: No surgeries or major health problems.

FH: Mother age 50, alive and well; diagnosed with Wilson's disease five years ago.

        Father age 53, alive and well.

EXAMINATION
Miss C's vital signs are good: BP 130/70mm Hg;  pulse rate is 85bpm. She is 5'6" tall and weighs 150lbs.

On physical examination:            

                HEENT:  NL

                Breasts: Negative for masses

                Chest: NL to auscultation

                Abdomen: + BS all 4 quadrants

                Genitalia:

                                Vulva: Shaved, no lesions

                                Vagina: Thick white discharge; wet prep-negative

                                Cervix: Clear, pap done

                                Uterus: AV, NT

                                Adnexa: No masses

DISCUSSION
Following a normal GYN exam with no significant findings, it is decided that Miss C is a candidate for long-acting reversible contraception such as levonorgestrel IUD, Nexplanon (etonorgestrel), or Depo-Provera (medroxyprogesterone acetate). Miss C cannot be considered a candidate for a copper IUD unless Wilson's disease is ruled out.