Clinical Scenarios

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.

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.”

LNG IUD as EC, IUD pain management, thrombosis risks with hormonal contraception, telehealth & medication abortion, adolescent contraception guidance

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.

Cancer and contraception, menstrual cups and IUD displacement, vaginal microbiome and contraceptives, OTC birth control knowledge gaps, early medication abortion follow-up

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.

Partner treatment for BV, pain and bleeding experiences during first-trimester abortion, interest in Rh testing and treatment for telehealth medication abortion.

Double dosing UPA for EC not needed for BMI > 30, postpartum implant placement and milk supply, mifepristone to increase efficacy of medication management of EPL.