Discussion – Contraception Options
The selected patient for this discussion is a 17-year-old newly sexually active female who is allergic to copper and has a BMI of 35. When thinking about contraception for this patient, one needs to think about her individual needs and health. Here are three options: Progestin-Only Pills (Mini Pills), Levonorgestrel Intrauterine Device (LNG-IUD), and Subdermal Implant (Nexplanon). Notably, each contraception option has pros, cons, indication,s and contraindications, as discussed below:
Progestin-Only Pills (Mini Pills)
Pros
- Suitable for individuals who are reactive to estrogen, such as those with a high BMI or a history of migraines.
- It can be started at any time without needing to wait for the next menstrual cycle.
- Effective when taken consistently at the same time each day.
Cons
- Requires strict adherence to a daily schedule; missing a pill by more than three hours can reduce effectiveness.
- Potential side effects include irregular menstrual bleeding, weight gain, and mood changes.
Indications
The mini pill is for women who are nursing their babies in the first six months but also other breastfeeding mothers, women with medical conditions such as obesity and those who like using non-surgical birth control methods (Segev et al., 2023).
Contraindications
Women with a history of breast cancer, liver disease, or severe arterial disease should avoid progestin-only pills.
Evidence
Cooper et al. (2022) report that progestin-only pills are effective and safe for women with a higher BMI; these do not present the same cardiovascular risks as combined oral contraceptives.
Levonorgestrel Intrauterine Device (LNG-IUD)
Pros
- Long-term protection (3-7 years, depending on the brand).
- Highly effective with a failure rate of less than 1%.
- Reduces menstrual bleeding and cramps over time.
Cons
- Initial costs can be high, though it is cost-effective over the long term.
- Possible side effects include spotting, cramping, and, in rare cases, uterine perforation.
Indications
LNG-IUD is ideal for women seeking long-term contraception with minimal maintenance. It is also suitable for women who cannot use copper IUDs due to allergies or those who prefer hormonal options.
Contraindications
Contraindications include active pelvic infection, unexplained vaginal bleeding, or severe liver disease.
Evidence
LNG-IUD is endorsed by the American College of Obstetricians and Gynecologists (ACOG) as a first-line contraceptive option for adolescents and women with higher BMI due to its safety and efficacy (Lanzola & Ketvertis, 2022).
Subdermal Implant (Nexplanon)
Pros
- Provides up to three years of protection.
- Requires minimal maintenance once inserted.
- Quick return to fertility after removal.
Cons
- Insertion and removal require a minor surgical procedure.
- Potential side effects include irregular bleeding, weight gain, and mood swings.
Indications
Nexplanon is suitable for women who desire long-term, reversible contraception without daily attention. Also, it is effective for women with high BMI without increased risk of thrombosis.
Contraindications
Contraindications include known or suspected breast cancer, active liver disease, or unexplained vaginal bleeding.
Evidence
Notably, the contraceptive implant is effective across all BMI categories, and this, therefore, makes it a reliable option for overweight and obese women (Patel et al., 2019).
Conclusion
In conclusion, for a 17-year-old newly sexually active female with a BMI of 35 and an allergy to copper, Progestin-Only Pills, Levonorgestrel Intrauterine Device, and Subdermal Implant offer viable contraceptive options. Each method presents unique advantages and potential drawbacks that must be considered in the context of the patient’s health needs and lifestyle. Discussing these options in detail with the patient will ensure informed decision-making and adherence to the chosen method. The supporting evidence highlights the safety and efficacy of these contraceptive methods for adolescents and women with higher BMI, providing a solid foundation for these recommendations.
References
Cooper, D. B., Mahdy, H., & Patel, P. (2022, November 24). Oral contraceptive pills. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK430882/
Lanzola, E. L., & Ketvertis, K. (2022). Intrauterine Device. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK557403/
Patel, R. C., Jakait, B., Thomas, K., Yiannoutsos, C., Onono, M., Bukusi, E. A., Wools-Kaloustian, K. K., & Cohen, C. R. (2019). Increasing body mass index or weight does not appear to influence the association between efavirenz-based antiretroviral therapy and implant effectiveness among HIV-positive women in western Kenya. Contraception, 100(4), 288–295. https://doi.org/10.1016/j.contraception.2019.06.011
Segev, L., Weitzman, G., Katz-Samson, G., Samson, A. O., Shrem, G., & Srebnik, N. (2023). Combined Hormonal Contraception during Breastfeeding—A survey of physician’s recommendations. Journal of Clinical Medicine, 12(22), 7110. https://doi.org/10.3390/jcm12227110
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Question 
Discussion Prompt
Choose one of the following patients and present THREE birth control options that you would recommend for them. Be sure to discuss the pros/cons/indications/contraindications for each method and support your recommendations with evidence. Initial post should be >250 words, in 7th edition APA format, and contain at least one high-level scholarly reference.
Contraception Options
17-year-old newly sexually active female, allergic to copper, BMI of 35.
28-year-old mother who is nursing her 12-week-old infant.
40-year-old woman with a history of migraines, smokes ½ pack cigarettes per day.
25-year-old newlywed who wants to start trying to conceive in 2 years.
36-year-old mother of 3 who states she does not want to have any more children.
Expectations