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DISCUSSION POST #1 Reply to Ashlesha

In this scenario, when I discuss with my client for Birth control options, I keep in mind the allergy of my patient because there was no association between BMI or weight and the effectiveness of hormonal contraceptives. All
 hormonal contraceptives are equally effective in heavier women. (Stacey D, 2023). The most important thing for adolescents is to explain each contraception option and let them know their effectiveness. I will discuss the three birth control methods: latex condoms, hormonal methods like pills, and an intrauterine device (IUD).

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Condoms: Male and female condoms are intended for one-time use only (Cash et al., 2021). A male condom offers triple protection from unintended pregnancy, the transmission of sexually transmitted disease (STD), and human immunodeficiency virus (HIV) when they are used correctly and consistently (Stover et al., 2017). Although no birth control or protection is 100% effective, condoms are adequately protected. 

Advantages: Condoms are the only method of birth control that helps prevent both pregnancies and the spread of sexually transmitted infections like HIV, chlamydia, and gonorrhea (Sharma et al., 2021).

Disadvantage: Some people can have allergies to condoms; most are made from latex. The improper use can lead to condom breaking and possible unwanted pregnancy and disease transmission. It cannot be reused. One condom per occasion. Some claim it can interfere with sensation. 

Indications:  use with every sexual encounter, oral, vaginal, or anal, to prevent pregnancy or STIs. Do not use expired condoms; use only the appropriate size with water base lubricants. 

Contraindication: Allergies to latex. Less sexual pleasure, slipping off during intercourse, and accidental ripping.

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Oral Contraceptive Pills: There are two types of oral contraceptive pills. The combined oral contraceptive pill contains estrogen and progesterone, the two female sex hormones that control the menstrual cycle. The progestin-only pill (mini-pill) with just one hormone. It is rarely prescribed for adolescents. (AAPCA, 2020)

Advantages:91% effective at preventing pregnancy, Lighter periods, Fewer cramps, and Improves acne. Reduces the risk of ovarian and endometrial cancers and iron-deficiency anemia.

Disadvantages: It must be taken every day at around the same time. This can be hard for some adolescents to remember. The doctor will explain what an adolescent should do if she misses a dose. Do not protect against sexually transmitted infections.

            Indication: for Birth control and regulates menstruation cycle.

Contra-indication: not advisable for women with smoke and are Aged>35 years old, History of DVT and HT and Migraines.

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Hormonal IUD:  A small, flexible, T-shaped birth control device inserted into the uterus by an experienced provider. There are two types: Copper T and Levonorgestrel IUD. The copper T380A IUD is contraindicated in women with a known copper allergy or Wilson disease. (Milton, 2021)

Advantages: It provides safe, long-term birth control, don’t forget to do anything every day, week, or month to stay protected from unintended pregnancy. May cramping and lighter periods with the levonorgestrel IUD. Many adolescents stop having periods over time.

Disadvantages: Can cause pain or cramping for a short time after insertion. Levonorgestrel IUD: This may include irregular bleeding or spotting. This often gets better after a while. Do not protect against sexually transmitted infections.

Indications: Levonorgestrel IUD is an option for adolescents and is a 99.8% effective birth control method; it contains a hormone and is replaced every 3 to 7 years.

Contra-indications: Pregnancy or suspected pregnancy, STDs or Lower genital tract infection, Uterine congenital abnormality. Gestational trophoblastic disease with persistently elevated beta-human chorionic gonadotropin levels. (Milton, 2021)        

DISCUSSION POST # 2 Reply to Jinkee

The combined oral contraceptive pill (COCP), the progestin-only pill (POP), and the contraceptive implant are three recommended birth control alternatives for a 17-year-old newly sexually active female who is allergic to copper and has a BMI of 35. Each method has advantages and disadvantages that should be discussed with the patient.

The first alternative, the COCP, includes both estrogen and progestin and, when used correctly, is quite successful in preventing pregnancy. It also has other benefits such as less cramping, lighter periods, and better acne. However, it may not be appropriate for people with a higher BMI due to a potential decrease in efficacy in preventing pregnancy in this population. As a result, the patient’s BMI should be continuously monitored, and if significant weight gain occurs, an alternative treatment may be sought. It is biologically plausible to consider an increased risk of complications from venous thromboembolism with the use of drospirenone-containing OCs as compared with other progestin-containing OCs.

The POP, often known as the mini-pill, contains only progestin and is appropriate for women who cannot tolerate estrogen. It is an excellent alternative for people who have contraindications to estrogen, such as the patient’s copper allergy. The POP is normally well-tolerated, but it must be administered according to a strict schedule in it to be effective. The most common adverse effect is irregular bleeding or spotting. While BMI has no effect on POP, it is crucial to underline the importance of constant and precise use to ensure efficacy.

The contraceptive implant is a long-acting reversible contraceptive technique that consists of a tiny rod inserted beneath the skin that releases progestin over time. It is quite effective, with less than 1% failure rate. Because the contraceptive implant is not impacted by BMI and does not include estrogen, it is appropriate for people with a higher BMI or who cannot handle estrogen. The most common adverse effect is irregular bleeding or spotting, which normally resolves within the first year of therapy. It is a convenient and unobtrusive method of contraception because it does not require daily maintenance. According to NIH website, special considerations include:

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A. If the implant is inserted within the first 5 days since menstrual bleeding started, no additional contraceptive protection is needed.

B. If the implant is inserted >5 days since menstrual bleeding started, the woman needs to abstain from sexual intercourse or use additional contraceptive protection for the next 7 days.

In summary, the COCP, POP, and contraceptive implant are the recommended birth control alternatives for a 17-year-old female who is allergic to copper and has a BMI of 35. Each alternative has pros and disadvantages that should be explored with the patient in order for her to make an informed decision based on her unique needs and preferences.