Latest Edition
Clinical scenario: Hormonal birth control side effects
An 18-year-old (she/her) started a combined hormonal contraceptive pill (COC) three months ago, prescribed by her primary care provider. She’s been taking a pill with 0.15 mg levonorgestrel/30 mcg EE. She’s now following up with you because she’s been feeling moodier since starting the pill. She’s not totally sure if the pill is to blame, but says it’s affecting her quality of life and she’s interested in talking about other options.
Clinical scenario: Pregnancy of unknown location & abortion care
A 21 year-old individual (they/them) presents requesting a medication abortion. Their LMP was five weeks ago. They had a positive home pregnancy test three days ago, confirmed in clinic. Transvaginal ultrasound shows no visible intrauterine pregnancy (no gestational sac or yolk sac) and no signs of ectopic pregnancy. They deny pelvic pain, bleeding, or spotting since their LMP.
Clinical scenario: Contraception and autoimmune conditions
A 24 year-old patient (she/her) comes into clinic. During the visit, she expresses interest in starting on a hormonal implant. She was diagnosed with systemic lupus erythematosus (SLE) six months ago and is currently taking hydroxychloroquine. The patient reports no history of low platelets, but she doesn’t know her antibody status at the time of the visit. She reports no other medical conditions or current medications.
Clinical scenario: Placing an IUD after unprotected sex
A patient in your clinic is requesting to have an LNG-IUD placed today. You note that their last menstrual period (LMP) started 10 days ago, and when asked about recent unprotected vaginal intercourse, they report they last had sex three days ago.
Clinical scenario: Managing abnormal cervical cancer screening tests
A 29 year-old patient (they/them) is transferring care into your practice. They show you that their medical record from a previous provider, pulled up on their phone, includes an ASCUS cytology with reflex positive Human Papillomavirus (HPV) three months ago without follow-up. They pull up other records on their cell phone of a prior normal cytology test at age 26. “What do I do now? I’m worried that I have cancer.”
Clinical scenario: Emergency contraception (EC) for transgender or gender nonbinary (TGNB) patients
A 19 year-old patient (he/him) comes to your emergency department in the early morning. He is seeking HIV post-exposure prophylaxis (PEP) following unprotected sex with a male partner the night before. During intake, he discloses that he is transgender and was assigned female at birth (AFAB). He is amenorrheic as a result of testosterone use for gender-affirming hormone therapy. At your facility, cisgender women seeking PEP are also offered EC.
Clinical scenario: Effects of birth control on lactation
A 25 year-old patient (she/her) is interested in starting birth control four weeks after having her first child. She is breastfeeding but needs to supplement formula one to two bottles a day because of “not having enough milk.” Prior to pregnancy she was happy with a hormonal implant but is unsure if this method is safe while producing milk.
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