Contraception not so easy . - guest78

[ArchivalUser]

A 46-year-old woman with gradually progressive menorrhagia attributed to perimenopause requests an effective nonsurgical approach to reduce menstrual bleeding. Physical examination, endometrial biopsy, and pelvic ultrasonography reveal no abnormalities. Laboratory testing shows iron deficiency anemia but is otherwise normal, including serum thyroid-stimulating hormone level. She is in a long-term monogamous relationship with her husband, using condoms, but would like more reliable contraception. She smokes 1.5 packs of cigarettes per day, having tried unsuccessfully to quit many times. She has put on weight with each attempt to quit smoking and does not wish to use any hormonal method that might contribute to weight gain. She has normal blood pressure, an excellent lipid profile, and no personal or family history of coronary artery disease or venous thromboembolic disease.
Which of the following approaches to contraception would be safe, effective, and likely most acceptable to her?


A. Combination oral hormonal contraceptive (after quitting smoking)
B. Transdermal hormonal contraceptive patch
C. Depot med roxyprogesterone acetate
D. Levonorgestrel intrauterine device
E. Endometrial ablation

[ArchivalUser]

D----------

[ArchivalUser]

DD

[ArchivalUser]

C:

[ArchivalUser]

d...............

[ArchivalUser]

dddd

[ArchivalUser]

i will go with D

[ArchivalUser]

dddddddddddddd

[ArchivalUser]

ddddddddddd

[ArchivalUser]

D.

This perimenopausal woman who smokes desires reduction in menstrual flow and more effective contraception, without chance of weight gain. Combination hormonal contraceptives would most likely be effective, but are contraindicated in her because heavy smoking significantly increases the risk of myocardial infarction, especially in women taking oral contraceptive pills. (The new transdermal formulation should be assumed to have this same potential, in the absence of data showing otherwise.) Though quitting smoking is clearly advisable, she sounds unlikely to make that change at this time. Depot medroxyprogesterone acetate would also likely be effective but commonly causes weight gain, the possibility of which would be unacceptable to her. The levonorgestrel intrauterine device would be the best of these options in this woman™s situation. It reduces menstrual blood loss in œidiopathic menorrhagia, provides effective contraception, has no or few systemic side effects, and can be left in for 5 years. Endometrial ablation would be another option but has a lower success rate at reducing menstrual blood loss than does levonorgestrel intrauterine device, and ablation may not prevent pregnancy