Clinical Scenarios

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.

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.”

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.

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.

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.

A 22 year-old patient (she/her) is currently using an IUD and had it placed at another clinic out of state three years ago. When asked which IUD she has, she is not sure, though she thinks it has hormones. She reports having light, irregular periods. Overall, she is satisfied with the IUD and wants to continue using an IUD for birth control.

Intrauterine mepivacaine for IUD placement, the impact of abortion restrictions on medical training, pregnancy of unknown location and very early medication abortion, and navigating abortion misinformation