Reliable Contraception for Smoker with Painful Menses
Mrs. G, a 35-year-old G2, P2 woman arrives at the office for an annual exam. She requests information on reliable contraception.
Mrs. G is well groomed and communicative. She is married and works full time as a clerical assistant in a dental office. Mrs. G considers herself to be healthy. She is “determined to quit” smoking (1ppd X 10 years). She reported one “abnormal pap” five years ago that “cleared up” on follow-up pap tests. Mrs. G complains that her periods, while regular, are becoming very heavy and painful.
PMH: Two spontaneous vaginal deliveries, no problems. Tonsillectomy and adenoidectomy at age 4.
FH: Father – Heart attack at age 55, but alive. Works full time and has discontinued smoking (1 ppd X 20 years)
Mother – Diabetic controlled by diet; hypertension – controlled by ACE inhibitor
On physical examination:
Chest: No adventitious sounds, clear to auscultation
Breast exam: Normal limits (NL)
Abdominal exam: + BS all quadrants with no tenderness
Vagina: Physiologic discharge
Cervix: Clear, pap done
Adnexa: NL, no masses
Assessment: Normal exam; need contraception
Due to Mrs. G's smoking status, she is not a candidate for combined hormonal (oral) contraceptive. Long-acting reversible contraceptive options were discussed and the patient was recommended a levonorgestrel intrauterine device (IUD) for contraception that will also reduce her painful menstrual symptoms.