Long-Acting Reversible Contraception in Young, Nulliparous Woman
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.
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.
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:
Breasts: Negative for masses
Chest: NL to auscultation
Abdomen: + BS all 4 quadrants
Vulva: Shaved, no lesions
Vagina: Thick white discharge; wet prep-negative
Cervix: Clear, pap done
Uterus: AV, NT
Adnexa: No masses
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.