Clinical Scenarios

A 21-year-old patient (she/her) presents to your health center after a positive home urine pregnancy test last week. Based on a sure last menstrual period (LMP), the patient currently has an estimated gestational duration of 6 weeks. When you ask how she's feeling about being pregnant, she pauses and says, "Honestly? I don't know. I think I could see myself going either way. I just don't know what the right thing to do is." She has a 3-year-old at home, a job she's not sure allows for more time off, and a partner she describes as "supportive but not pushing me either way." She denies urgent safety concerns and has no significant medical history.

A 29-year-old G2P1 (she/they) presents for medication abortion at 8 weeks of gestation, consistent with a 6-week ultrasound demonstrating a single intrauterine pregnancy. She reports, “I think I got a shot after I had my son. Do I need a shot before I take the pills?" She reports her previous pregnancy was uncomplicated. She is not certain of her prior Rh status. She is not certain about a desire for future pregnancies.

A 22-year-old G1P0 patient comes in after a positive home urine pregnancy test two weeks ago. While waiting for their visit with you, they went to a local crisis pregnancy center (CPC) for a free ultrasound. The CPC estimated they were 7 weeks. During the visit, they were told that abortion significantly increases the risk of breast cancer. They are feeling ambivalent about continuing this pregnancy or having an abortion and not sure what to believe. 

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.”

A 26-year-old (she/her) presents to your health center four weeks after a medication abortion at eight weeks of gestation. She reports bleeding was initially heavy with blood clots, and is now lighter, but she continues to have intermittent light bleeding and mild cramping. She reports she believes she is not pregnant anymore, as pregnancy symptoms have resolved, but is not sure if things are "done."  A transvaginal ultrasound shows a heterogeneous collection and thickened endometrial stripe, without a persistent gestational sac or evidence of an ongoing pregnancy.

What providers need to know about supporting patients who want to use fertility awareness-based methods

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?”