CASE STUDY - CONTRACEPTIVES
Patient: Female, 35 years old, non-smoker, BMI 26, she has three children
Laboratory values, examination: TK 118/75
Family history: No risk factors are described in the mother or father
Personal history: depression
Medical history: ethinylestradiol 35 micrograms / norethisterone 1 mg
citalopram 10mg 1 - 0 - 0
She is coming for an advice. She began to take combined hormonal Contraception (COCP) six
months ago. Since then, she has always suffered from severe headaches - migraines without
aura, at weekly pauses without contraception.
Tasks:
1. Analyze the prescription of drugs, include active substances, classification according to
ATC classification, and brief mechanism of action of individual products, check dosage and
method of use (morning / evening, before / after meals, etc.)
2. Find any interactions between the products. Can some antidepressants interact with
contraception? What is the possible mechanism of this interaction?
3. Is there a connection between the use of contraception and headaches? What side effects
are most commonly found in combined contraception patients?
4. What types of oral contraception exist? Is it necessary to replace the current
contraception with another, preferable to this patient, or continue with the current one?
5. What type of contraception would you recommend to this patient? What options (drug
forms, preparations) of contraception, other than oral, exist?
6. What type of contraception would you choose for this patient as the most appropriate
taking into account the above facts and why?
7. What are the criteria for choosing long-term contraceptives (implants, intrauterine
devices)?