Reference no: EM133843022

Question 

BW is a 23-year-old woman who presents for a well-woman examination and resumption of contraception.

Her last menstrual period began 8 days ago, occurred at the expected time, lasted a normal number of days for her, and flow was her normal amount. In the past she has used combined oral contraceptives but reports that she has "so much extra bleeding no matter what pill she tried."

Upon further questioning, she tried two different brands of "very low-dose newer" pills, using each for two cycles before abandoning pills altogether. With each brand, she had spotting for several days during active pills as well as during the inactive pills.

Currently, she is using condoms for contraception with most acts of intercourse but has used emergency contraception twice during the past 5 months due to condom breakage.

She recalls that she had trouble remembering to take the pill daily due to her erratic schedule while in college, but she states that she is willing to try pills again because she knows of their efficacy in preventing pregnancy. She has been in her current intimate relationship for 9 months, which is consensual and mutually monogamous.

Menarche occurred at 12 years and she has regular menses every 28 to 32 days, lasting 4 to 6 days, with minimal dysmenorrhea on the first day ameliorated by use of OTC doses of ibuprofen. She denies sexually transmitted infections or abnormal Pap smears.

Her physical examination reveals height 5'7," weight 175 lb (BMI is 27.4), and BP 126/74.

1. Does BW have any contraindications noted to contraception?

2. What would be your initial management plan including counseling and follow up?