I had a couple of interesting contraception cases during my clinical rotation. The first was a 21 year old G2P2 who came in to the gyn clinic because she wanted to be fitted for a diaphragm. The only thing she used with her husband in the past for contraception was condoms and spermacide. She had no previous experience with diaphragms but had found out about them on the internet. She was interested in using it because she was very adamant about not using any type of hormonal contraception. So basically, I had to start from scratch and tell her everything about diaphragms. It was interesting to me that someone so young would want a diaphragm, because you usually think of older women using them. But I think with the younger generation being more disinclined to use medications, we may see more diaphragms come into play.
Another case was a 24 year old G1P1 female who came in because she was interested in starting new contraception. She reported that she had tried an oral contraceptive in the past with good results and she had only come off to have her child. During the interview, the patient revealed that she has very heavy menstrual cycles every month and the oral contraceptives never seemed to help that much. After talking with the patient, I thought that she would benefit from the Mirena IUD. So, I started discussing the risks and benefits with her and she was on board until I mentioned that the Mirena could help decrease her menstrual flow and in time may even stop her period. She then commented that it is "not natural" for a woman to not have a period and that she would rather have heavy cycles than not have a period. No amount of education from us could change her mind, so we prescribed the oral contraceptives. It was just interesting to see these two patients with such strong viewpoints on contraception.
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I think it is even more amazing that a woman would rather have a heavy period than the chance to have little to none! I'm hoping the 24yo was either married and/or in a monogomous relationship as it appears her principle concern was pregnancy prevention...Not that the IUD adds any added protection against STIs, I wonder how she might feel in a few more years about heavy menstrual bleeding and if her "very heavy periods" were truly "heavy." It would seem that by her declaring it a problem in the first place that she was seeking resolve along the lines of a "lighter" period.
ReplyDeleteWow! Even with all the education, safety, and efficacy with the use of different contraceptives today, with access to finger-tip information, we might start seeing a new wave of health care issues. Hmmm, more unintended pregnancies? Anemias? STIs?
You just NEVER know where a patient's going to stand on a particular issue - and talking with them/education is the key. If you don't know (really know) what their concerns are, you'll never be able to help them choose the method that they'll be able to stick with for the long haul.
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