Full Answer Section

• • Past Medical History: G3P3, menorrhagia, migraines with aura, osteoarthritis.
  • Medications: Ibuprofen (PRN), Omeprazole (PRN).
  • Allergies: NKDA.
  • Social History: Occasional alcohol use, denies tobacco or illicit drug use.
  • Family History: No significant family history of clotting disorders or breast cancer.
• O (Objective):
  • Vital Signs: BP 120/80 mmHg, HR 72 bpm, RR 16, Temp 98.6°F.
  • Pelvic Exam: Normal external genitalia, normal cervix.
  • Labs: Recent normal CBC.
• A (Assessment):
  • Patient desires contraceptive management.
  • Considerations: Age, menorrhagia, migraines with aura, osteoarthritis.
• P (Plan):
  • Shared Decision Making: Discussed various contraceptive options, including:
    • Levonorgestrel-releasing intrauterine system (LNG-IUS): Addresses menorrhagia, long-acting, minimal systemic hormones.
    • Copper intrauterine device (Cu-IUD): Non-hormonal, long-acting.
    • Progestin-only pills (POPs): Suitable for migraines with aura, but may not address menorrhagia.
    • Combined hormonal contraceptives (CHCs): Contraindicated due to migraines with aura.
    • Sterilization: a permanent option.
  • Patient elected to proceed with the LNG-IUS.
  • Patient Education:
    • Explained the benefits and risks of the LNG-IUS, including potential for spotting, amenorrhea, and rare complications.
    • Provided information on insertion procedure and follow-up.
    • Discussed the importance of regular pelvic exams and STI screening.
    • Explained that the LNG-IUS is very effective at reducing heavy bleeding.
    • Counseling on alternative methods were also provided.
  • Follow up in 4 weeks for IUS placement check.

Rationale Based on US MEC and Evidence-Based Guidelines:

• LNG-IUS:
  • According to the US MEC, LNG-IUS is generally safe and effective for women over 40.
  • It is particularly beneficial for women with menorrhagia, as it often reduces or eliminates menstrual bleeding.
  • The progestin only component makes it safer for patients with migraines with aura, than combined hormonal contraceptives.
• Cu-IUD:
  • A non-hormonal option, suitable for those avoiding hormones.
  • Effective and long-acting.
  • Can increase menstrual bleeding and cramping, which is a contraindication for this patient.
• CHCs:
  • Migraines with aura are a contraindication for CHCs due to increased risk of stroke.
  • US MEC Category 4.
• POPs:
  • Safe for patients with migraines with aura.
  • May not adequately address menorrhagia.

Lifelong Learning Strategies:

To continue developing my knowledge and skills in women’s health, I will implement the following strategies:

1. Regularly Review Evidence-Based Guidelines:
   • I will stay up-to-date with the latest recommendations from organizations like the US MEC, ACOG (American College of Obstetricians and Gynecologists), and WHO (World Health Organization).
   • This includes subscribing to relevant journals and participating in continuing education activities.
2. Engage in Interprofessional Collaboration:
   • I will seek opportunities to collaborate with physicians, pharmacists, and other healthcare professionals to enhance my understanding of complex women’s health issues.
   • This includes attending interdisciplinary conferences and participating in case discussions.
3. Promote Diversity, Equity, and Inclusion (DEI):
   • I will actively seek out educational resources and training on cultural competency and implicit bias.
   • I will strive to create a welcoming and inclusive environment for all patients, regardless of their background or identity.
   • I will actively seek out information on health disparities that affect women of different backgrounds.
   • I will examine my own biases, and how they effect patient care.

Evidence-Based Sources:

• Centers for Disease Control and Prevention (CDC). (2016). United States Medical Eligibility Criteria for Contraceptive Use, 2016. Retrieved from: https://www.cdc.gov/reproductivehealth/contraception/mmwr/mec/index.htm
• American College of Obstetricians and Gynecologists. (ACOG). (Various Clinical Practice Guidelines). Retrieved from: https://www.acog.org/clinical-information/clinical-guidance/practice-advisory
• World Health Organization. (WHO). (2015). Medical eligibility criteria for contraceptive use. Retrieved from: https://www.who.int/reproductivehealth/publications/family_planning/MEC-5/en/
• Curtis, K. M., Tepper, N. A., Jatlaoui, T. C., Zapata, L. B., & Gavin, L. (2016). U.S. medical eligibility criteria for contraceptive use, 2016. MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports, ¹ 65(3), 1–103.  
  1. sagij.org.ar

  sagij.org.ar

This SOAP note, plan of care, and lifelong learning strategy outline the steps for providing patient-centered and evidence-based care for women seeking contraception.