A 33-year-old female requests combined oral contraceptive pills (OCPs) for birth control.
Which one of the following would be a contraindication to prescribing OCPs for this patient?
Correct Answer C:
Contraindications to the use of oral contraceptive pills (OCPs) include previous thrombosis, preexisting vascular disease, coronary artery disease, congestive heart failure, active liver disease, estrogen-dependent cancers, breast cancer, and untreated hypertension. Patients whose hypertension is well controlled can take OCPs. Current smoking would be a contraindication in a patient over 35 years of age. There is some evidence that OCPs may protect against ovarian cancer.
An 18-year-old female college freshman, who says she has never been sexually active, has just begun a serious relationship with a 19-year-old male. Although they have not yet engaged in sexual intercourse, she wants to begin oral contraception. Her periods are regular. She began her current menses 2 days ago and would prefer to delay a pelvic examination until her period has ended. Her blood pressure is normal.
Which one of the following is the most appropriate plan for this visit?
Correct Answer A:
A history, pregnancy test (if indicated), and blood pressure reading constitute an adequate evaluation before beginning hormonal contraception. The pelvic examination may be deferred to a later visit.
It is now recommended that cervical cytology screening should be initiated at 21 years of age for women who are or have ever been sexually active, neither of which have occurred in this case. However, sexually active women under the age of 25 should be screened for chlamydial infection. If a pregnancy test were necessary it could be done at the initial visit, but waiting another 2 weeks delays the initiation of birth control, increasing the risk for pregnancy.
A healthy 40-year-old woman requests oral contraceptives. As her sole health care provider, appropriate evaluation includes all of the following, except:
Routine health care screening is still necessary in this patient. This will include a regular Pap smear, fasting blood glucose, routine vital signs, height, weight, BMI. Endometrial sampling is not required.
→ Regular Pap tests are indicated.
→ In female patients > 40 or earlier if risk factors present, fasting blood glucose is indicated.
→ Routine vital signs are part of the necessary yearly health care screening.
Oral contraceptive pills have been shown to protect from which of the following cancers?
It has been observed by several researchers that oral contraceptive pills (OCP’s) use decreases the risk of uterine cancer. Oral contraceptives thin the lining of the uterus, resulting in a decreased monthly menstrual flow for women, as well as a decreased rate of mitosis (division) for a woman's endometrial cells. This results in an overall decreased risk of uterine cancer.
Combination oral contraceptives would be contraindicated in which one of the following?
Correct Answer D:
According to the World Health Organization, an individual with a previous history of deep venous thrombosis should not use combination oral contraceptives. The advantages outweigh the disadvantages in nonsmokers over 40, smokers under the age of 35, and obese women. Combination contraceptives can be used with caution or special monitoring in individuals with migraine headaches without focal neurologic symptoms who are less than 35 years old.
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