Women Health – Week 3 Discussion 2nd REPLY

Please reply to the following discussion with one reference. Participate in the discussion by asking a question, providing a statement of clarification, providing a point of view with a rationale, challenging an aspect of the discussion, or indicating a relationship between two or more lines of reasoning in the discussion. Cite resources in your responses to other classmates.
Discussion
As primary care providers, it is our responsibility to understand the efficacy, safety, appropriateness of contraceptive methods for our patients.  Given Karen’s history of menorrhagia and dysmenorrhea, migraines, tobacco use, and family history, elevated blood pressure, and lack of desire to become pregnant, I would recommend a contraceptive implant/intrauterine device (IUDs) or a tubal ligation/sterilization.  The increased usage of intrauterine devices has contributed to decreased pregnancy rates in the United States.  Evidence based practices have amplified the figure of women who are medically entitled for intrauterine devices and have permitted expedited access to the methods (Nelson & Massoudi, 2016).  Presently, women can choose from three hormonal IUDs, the Mirena, Liletta, and the Skyla; or they can choose the only non-hormonal IUD, the Paragard (Nelson & Massoudi, 2016).  In Karen’s case, I would advise that she utilize one of the hormonal IUD options.  Additionally, if Karen chooses not to utilize a hormonal IUD, the next option she would be medically eligible for is a tubal ligation/sterilization.  Nationally, more than 220 million couples chose sterilization as a desired form of contraception, as it has been proven to be safe and effective for those no longer desiring to reproduce (Sung & Abramovitz, 2021).
Identify one method that you feel would be most beneficial to Karen and discuss why you selected it.
A conversation should take place with Karen to determine whether or not she desires additional children in the future.  Her decision would ultimately impact the method of contraception I would recommend to benefit her well-being and family planning goals.  Given the fact that Karen is in a new relationship, her relationship may escalate with her current partner.  Her partner may communicate his desire to have children, which may alter her views on reproduction.  With that being said, I would recommend that Karen utilize the Mirena.  Studies have found the Mirena to be the most effective medical therapy for menorrhagia and dysmenorrhea, and has improved the lives of approximately 94.6% of women after using the Mirena for 6-12 months (Nelson & Massoudi, 2016). This method will offer her a period benefit by decreasing blood loss, prevent unwanted pregnancy, is reversible, and possess a decreased risk for cardiovascular disease and venous thromboembolism given her history. 
Are there any methods that you would not recommend for Karen? Why?
The first method of contraception that I would not recommend for Karen, is the Paragard Intrauterine device considering she is currently suffering from menorrhagia and dysmenorrhea.  According to Nelson and Massoudi (2016), studies have found dysmenorrhea and abnormal bleeding patterns are associated with the Paragard, causing an increase of blood loss by 30%-50%.  The second method of contraceptive I would not recommend for use are combined hormonal contraceptives, such as the pill, transdermal patch, and ring.  Studies have shown there is an increased risk for venous thromboembolisms and cardiovascular disease associated with certain disease processes and social habits.  Due to these risks, contraindications are in place for the utilization of combined hormonal contraceptives for women with the following issues: a history of migraines, uncontrolled hypertension, age of 35 years or older with a smoking history, ischemic heart disease, past or active history of valvular heart disease, endometrial cancer or breast cancer (Cooper & Mahdy, 2021).  Thirdly, I would not recommend the use of the Depo-Provera shot, as studies have found reduced bone mineral density with prolonged use and an increase in weight, approximately 2-3 kg per year (Khadilkar, 2018).    
References
Cooper, D., & Mahdy, H. (2021). Oral contraceptive pills. Treasure Island (FL): StatPearls Publishing; https://www.ncbi.nlm.nih.gov/books/NBK430882/
Khadilkar, S. (2018). Short-term use of injectable contraception: An effective strategy for safe motherhood. Journal of obstetrics and gynaecology of India, 68(2), 82–87. https://doi.org/10.1007/s13224-017-1029-9
Nelson, A. L., & Massoudi, N. (2016). New developments in intrauterine device use: focus on the US. Open access journal of contraception, 7, 127–141. https://doi.org/10.2147/OAJC.S85755
Sung, S., & Abramovitz, A. (2021). Tubal ligation. Treasure Island (FL): StatPearls Publishing; https://www.ncbi.nlm.nih.gov/books/NBK549873/