Clinical Scenarios

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

LNG-IUD and the risk of gynecologic and breast cancers, contraception and body weight, and preferred ways to get hormonal birth control.

Ongoing support for forgoing Rh testing in early pregnancy, medication abortion before six weeks, provider bias on contraceptive counseling adolescents, and local anesthesia before procedural abortion.