Clinical Scenarios

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?”

A 19-year-old patient (she/they) comes in for STI testing since they recently started seeing someone new. After reviewing their sexual history and ordering appropriate testing, the provider checks in about how their birth control pills are working for them–the chart indicates they’ve been on a combined oral contraceptive for about a year. They reply, “Oh. I stopped taking them a couple of months ago–I heard it's good to take a break once in a while.”   They don’t report side effects and share that the decision was driven by things they kept seeing online. They are not interested in having kids anytime soon.

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.

25 y.o G0 patient (she/her) comes into the clinic for an emergency department (ED) follow up. She has a history of endometriosis and has been using a LNG 52mg IUD for contraception and management of heavy menstrual bleeding. She has no other medical conditions and does not take other medications. She went to the ED for new onset shortness of breath and was diagnosed with a spontaneous pneumothorax (collapsed lung), which was ultimately discovered to be a catamenial pneumothorax.

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.

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.

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.