Birth Control

A 23-year-old G1P1 (she/her) is coming in for her first postpartum visit after a normal spontaneous vaginal delivery. She was supposed to come for a 2-week check-in, but missed the appointment. She is now 4 weeks postpartum. She reports the baby is doing well. She is feeling fine, currently breastfeeding and tells you she stopped spotting “a while ago.” She had vaginal sex with her partner 2 days ago for the first time since delivery and they used a condom. Toward the end of her pregnancy, she indicated she wanted to get a copper IUD and now asks you if you can place it today. Her partner went back to work and childcare for an extra visit is difficult.  

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A 24-year-old (she/they) presents to your health center requesting an IUD. They filled out her intake form online and noted they are "nervous about procedures." As you are sounding their uterus, they say they feel "kind of weird." You ask for more detail, and they report they are a little sweaty and like they need to go to the bathroom. The medical assistant notes that their face has “gone pale.”

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A 24-year-old patient (she/her) comes in after missing a period. She has a history of PCOS and irregular periods, but reports her periods have been fairly regular over the past several months. In the clinic, her urine pregnancy test is positive. She is surprised and upset, as she’s been using a combined oral contraceptive (COC) for the past 2 years. On further history, you learn she started a weekly GLP-1 injectable for weight loss about 6 months ago that she gets from a local med spa. She doesn’t remember the exact name but thinks it starts with a “s.” Since starting the injection, she’s had intermittent nausea and a few episodes of vomiting, especially in the days after injections and after she increases the dose. She asks “how did this happen?”