contraception CJ

Requesting renewal of birth control

«no side effects presently»
periods are «regular» • «no dysmenorrhea» «no breakthrough bleeding»
using condoms for protection against STIs
smoking: «yes: • pk/yr»«no»
last pap smear: •

No Hx of: «bloodclots» «liver disease» «CVA» «HTN» «migraines»

O/E: BP : •

Assessment and Plan: renewal see rx
advised to: «use condoms for protection against STIs» «to have regular pap smear screening» «advised to not smoke as it increases the risks of cardiovascular events»
See MD for assessment if side effects or problems arise


Contraceptive Initial Visit:

S: «pt requesting birth control» for «contraception», «dysmenorrhea», «irregular periods», «acne»
- «never on OCP»«prev. tried • x • «mo»«years»», «hx s/e - •»«denies problems or s/e»

- LMP: •, «regular»«irregular», «no dysmenorrhea», «no breakthrough bleeding» «no dyspareunia»
- «not currently» «in a relationship» x • «mo»«yrs», «monogamous»
- using condoms for STI protection - «always»«sometimes»«never»«N/A»
- last pap smear: •, «normal»«abnormal»
- last vaginal swabs: •, «normal»«abnormal»

Risk Factors:
- «non-smoker»«smoking» x • cig/day
- «no» hx blood clots, liver disease, CVA, HTN, migraines with aura

Absolute Contraindications:				Relative Contraindications:
- <6 wks post-partum & breastfeeding			- >6 wks post-partum & low milk supply
- smoker >35 y/o (>15 cig/day)				- smoker >35 y/o (<15 cig/day)
- uncontrolled HTN				- controlled HTN
- hx of VTE/PE
- hx of CAD, CVA, or valvular heart disease
- migraine with aura and/or focal neurologic signs		- migraine >35 y/o
- cirrhosis or liver tumour (adenoma/hepatoma)		- sx gallbladder disease or hx OCP-induced cholestasis or mild cirrhosis
- DM with retinopathy/neuropathy/nephropathy		- on meds that affect metabolism of OCP (e.g. antibiotic, anti-seizure)
- breast CA (current)
	

Counselled re: benefits of OCP: 			Counselled re: risks of OCP: 
- protection from pregnancy (97%)			- increased thromboembolic events
- cycle control (decreased cramps/bleeding)				- DVT 3-4x (at 30 y/o, baseline risk 4/100,000)
- decreased acne (Alesse/Tricyclen/Diane 35)				- MI 3x (at 30 y/o, baseline risk 2/100,000)
- decreased PID					- CVA 2x (at 30 y/o, baseline risk 3/100,000)
- decreased ovarian CA (50% after 8 years)			- increased risk breast CA
- decreased uterina CA (67% after 8 years)				- breast CA 1.5x (at 35 yo, baseline risk 2/100,000)
- decreased benign ovarian cysts			- headaches ('rule of thirds")
					- increased gall bladder disease
					- nausea, spotting, breast tenderness, mood changes, yeast infections
					- no protection from STI, advised to use condoms regularly
					- no wt gain

O: «NAD», BP: • 
- urine pregnancy test: «negative»
- pap/swabs: «done»«up to date»

A+P: contraceptive - «no absolute contraindications», «no relative contraindications»
- «counselled re: risks/benefits of combined estrogen/progestin contraceptive»
- «d/ other options incl. patch, NuvaRing, POP, Depo-Provera, IUD (coppes), IUS (Mirena)»
- «pt prefers •», «rx given for • x 4 mo»
- «counselled re: Sunday start», «counselled re: missed pills depending whether week 1 or weeks 2-3 or pack»
- pap: «up to date»«due •, advised to book appt»
- «advised re: importance of regular pap smears»
- «advised to use condoms consistently to protect again STIs»
- «advised to quit smoking as increased risk of CV events»
- family planning: «N/A», «counselled to start folic acid 3 mo prior to stopping OCP, when ready to conceive»
- «f/u in 4 mo if s/e or concerns»



Contraceptive Renewal/Counselling:

S: «pt requesting birth control Rx renewal»
- on «OCP» x • «mo»«years», denies problems or s/e
- LMP: •, «regular»«irregular», «no dysmenorrhea», «no breakthrough bleeding», «no dyspareunia»
- «not currently» «in a relationship» x • «mo»«yrs», «monogamous»
- using condoms for STI protection - «always»«sometimes»«never»«N/A»
- last pap smear: •, «normal»«abnormal»
- last vaginal swabs: •, «normal»«abnormal»

Risk Factors:
- «non-smoker»«smoking» x • cig/day
- «no» hx blood clots, liver disease, CVA, HTN, migraines with aura

O: «NAD», BP: • 

A+P: «contraceptive» - • «renewed, see rx»
- pap: «up to date»«due •, advised to book appt»
- «advised re: importance of regular pap smears»
- «advised to use condoms consistently to protect again STIs»
- «advised to quit smoking as increased risk of CV events»
- family planning: «N/A», «counselled to start folic acid 3 mo prior to stopping OCP, when ready to conceive»
- «f/u prn if s/e or concerns»