Case Study: Jane J.
Jane is a 22 year old female who has recently become sexually active with her boyfriend. She is currently enrolled in college and is planning to graduate in 2 years. She has aspirations of becoming an accountant after she finishes school. She knows she is not ready to have children and wants to begin some kind of birth control to prevent becoming pregnant. She has read about different types of birth control and is interested in taking the birth control pill but has read so many different things on the internet and is not sure whether the pills are safe for her to take.
Are birth control pills safe?
Yes, hormonal birth control methods, such as the pill, are safe for most women. Today's birth control pills have lower doses of hormones than in the past. This has lowered the risk of side effects and serious health problems. Today's birth control pills can have health benefits for some women, such as a lower risk of some kinds of cancer. Also, different brands and types of birth control pills (and other forms of hormonal birth control) can increase your risk for some health problems and side effects. Side effects can include weight gain, headaches, possible irregular bleeding, breast tenderness, and mood changes. Talk to your doctor about whether hormonal birth control is right for you.
Jane's First Appointment:
When Jane arrives we initially talk about why she is interested in birth control. Sometimes women want birth control for not only preventing pregnancy but also to control the heaviness of periods, decrease pain with periods and regulate period cycles. We establish that she would like to prevent pregnancy, but also she states that her periods are very irregular and sometimes she is caught off guard with unexpected bleeding. After we review her health history, which is normal except for the fact she smokes cigarettes only socially, we discuss the options for birth control as well as the risks and benefits of each.
Different forms of birth control have different health risks and side effects. Some birth control methods that increase your risk for health problems include:
Hormonal birth control. Combination birth control pills (birth control with both estrogen and progesterone) and some other forms of hormonal birth control, such as the vaginal ring or skin patch, may raise your risk for blood clots and high blood pressure. Blood clots and high blood pressure can cause a heart attack or stroke. A blood clot in the legs can also go to your lungs, causing serious damage or even death. These are serious side effects of hormonal birth control, but they are rare.
Spermicides (used alone or with the cervical cap, diaphragm or sponge). Spermicides that have nonoxynol-9 can irritate the vagina. This can raise your risk for getting HIV. Use spermicides with nonoxynol-9 only if you are in a monogamous relationship (you have sex only with each other) with a man you know is HIV-negative. Also, medicines for vaginal yeast infections may make spermicides less effective.
Intrauterine devices (IUDs). IUDs can slightly raise your risk of an ectopic pregnancy. Ectopic pregnancies happen when a fertilized egg implants somewhere outside of the uterus (womb), usually in one of the fallopian tubes. An ectopic pregnancy is a serious medical problem that should be treated as soon as possible. IUDs also have a very rare but serious risk of infection or puncture of the uterus.
Jane's Treatment Plan:
After talking about the options available to her, she will begin taking birth control pills. We discussed the importance of her taking the pill regularly, and she agrees to also stop smoking cigarettes completely to decrease her risk of complications of using birth control pills while smoking.
What are the health risks for smokers who use birth control? If you smoke and are 35 or older, you should not use hormonal birth control. Smoking tobacco and using hormonal birth control raises your risk for blood clots and high blood pressure. Smoking and high blood pressure are risk factors for a heart attack or stroke. The risk for a heart attack or stroke also goes up as you age.
Jane's Followup:
Jane returned 3 months after beginning her birth control pills for followup. She has gotten into a good routine of taking her pill at the same time each day. She has not had any side effects since beginning the pill, and she has stopped smoking.
Misconceptions:
Birth control pills cause significant weight gain: This is not true. For the majority, the average amount of weight a woman might gain when beginning birth control pills, is 5 pounds in one year. With consistent healthy diet and exercise, most women gain no weight.
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