Pediatric Primary Care Case Studies (111 page)

Jaime is very active, playing on her school volleyball and cheer teams. She travels with her teams frequently, which could cause her schedule to be erratic. Any contraceptive that would need a strict schedule could be affected.

Another risk that you must consider for Jaime is that of partner violence. Blair refuses to use condoms at times; this could potentially cause discord in the relationship. Women who do not feel that they have power in their relationships are less likely to use condoms with each sexual act (Harvey, Bird, Galavotti, Duncan, & Greenberg, 2002). Although Jaime has not said anything today that warrants concern, it would be advisable to consider this possibility for her.

Jaime is not communicating with her mother throughout this situation. Although this is not unusual for adolescents, Jaime might find her mother’s insights helpful because Jaime’s mother was an adolescent when Jaime was born. When adolescents do talk with their parents about contraceptive use, they are more likely to consistently use contraceptives (Manlove, Ryan, & Franzetta, 2003).

Jaime suffers from menorrhagia and dysmenorrhea with her monthly menses. Some contraceptive methods could potentially decrease her symptoms. It would be important to discuss these with Jaime and assist her to choose a contraceptive that could decrease her flow of blood and alleviate some, if not all, of her cramping.

Jaime would like to prevent a pregnancy without jeopardizing her future ability to have children. Her contraceptive needs should be effective, reversible, not linked to coitus, and assist in preventing sexually transmitted infections. Adolescents at this stage have the cognitive ability to make good decisions; however, they do not always make the most appropriate decisions in light of future consequences (Commendador, 2003). When adolescents have higher self-esteem, they tend to make decisions that are better for them (Commendador). Jaime, however, tends to allow Blair to decide whether or not he wants to use a condom when they have sex. This is not uncommon because Blair is older than Jaime; however, this means the chances that they will use contraception with intercourse decreases. Older partners tend to have a greater influence on the adolescent (Manlove et al., 2003).

What contraceptive options should you consider? What are the advantages and disadvantages of each option? Which would be reasonable options for Jaime?

A list of possible contraceptives is provided in
Table 28-1
, and discussed here:

•   Abstinence

   
Advantages:
Nonhormonal, no need to remember to take a pill every day.

   
Disadvantages:
There are no risks to abstinence. except that it requires self control under all circumstances. This is the only 100% effective and safe method of contraception, if followed (Caufield, 2004; Kowal, 2007). Once an adolescent has become sexually active, it is unlikely that he or she will cease having intercourse, especially if he or she continues in the same relationship (Chambers & Rew, 2003).

   Option for Jaime: Although a good option for any adolescent, this is not likely an option Jaime will choose.

•   Combined estrogen/progesterone (oral, transdermal, transvaginal)

   
Advantages:
Highly effective in preventing pregnancy when taken correctly; not related to coitus; rapid return to fertility after discontinuation; very safe when prescribed for appropriate users; can be used throughout the reproductive years; decreased maternal deaths; reduction in risk of ectopic pregnancy; decrease in dysmenorrhea; decrease in menorrhagia; reduction in premenstrual syndrome (PMS) symptoms; reduction in endometrial and ovarian cancer risks; decrease in benign breast conditions; improvement of androgen-sensitivity or androgen-excess conditions (such as PCOS).

   
Disadvantages:
Must be taken consistently and correctly to be effective; storage, access, lack of privacy; no protection against STIs. Common side effects include nausea, vomiting, weight gain, decrease in libido, headaches, breast tenderness, and skin hyperpigmentation. The transdermal form may be linked to an increased risk of thromboembolic disease because of higher concentrations of estrogen in the system.

   
Contraindications:
Personal history of thrombosis, known clotting disorder, personal history of stroke or MI, labile hypertension, estrogen-sensitive malignancy, active liver disease, migraines with focal neurologic symptoms.

   
Complications:
Venous thromboembolism, myocardial infarction, stroke, hypertension, liver disease (Caufield, 2004; Nelson, 2007).

   Option for Jaime: Any one of these methods could be an option for Jaime, but not alone. These methods do not protect against STIs, so it would be essential for Jaime to also use condoms to decrease transmission of STIs.