A 28-year-old nonsmoking woman presents to discuss birth control methods. She requests a contraceptive option that is not associated with weight gain. She and her husband agree that they desire no children for the next few years. Her periods are regular, but heavy and painful. She frequently stays home from work on the first day due to severe lower abdominal cramping and back pain. She changes her pad every 4 hours. This pattern of bleeding has been present since she was 15 years old. For a week before her period begins, she is uncharacteristically tearful, irritable, and depressed. These behavioral changes are beginning to affect her personal relationships. Her physical examination reveals blood pressure 110/75, BMI 22, and moderate acne on her face and neck. What recommendation would best address her mood, skin, and contraceptive needs?
While each of the options will provide contraception, only the combination pill fulfills all of her requests. Tubal ligation represents permanent sterilization and will not help her mood swings or dysmenorrhea. Progesterone-infused IUDs provide convenient and effective reversible contraception; they usually decrease menstrual flow and do not cause significant weight gain. IUDs, however, are not effective in treating acne or premenstrual dysphoric disorder (PMDD). Progesterone intramuscular injections are associated with weight gain. Condoms do not provide benefits beyond contraception and protection against sexually transmitted infections. The only FDA- approved contraceptive pill for PMDD is a Drospirenone/ethinyl estradiol combination.
Tubal ligation
Drospirenone/ethinyl estradiol combination pill
Progesterone-infused intrauterine device
Depo-progesterone shots every 3 months
Miscellaneous