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Contraception Posted by NAHID H.

Patient should ask if she has any complains at time  of pesentation like bleeding or abdominnal pain to manage first . Tak obtetric history  , of  her previous  pregnancies and if there were any complication during pregnancy or at termination ,ask about her menses is it regular  ,normal in amount and duraion or associate with pain , and the LMP . We ask her if she used contraception before and what type of contraception ,for how long and it efficacy .We ask about her past medical history of DM , hypertention.thyroid disease or thrombotic illness. drug history also important like enzyme induser or teratogenic drugs . We ask about alcohol or drug abuse ,numbers of parteners and if any history of sexxually transmitted disease and her financial status . We should exmine the patient , pulse BP ,abdominal and vaginal examination for masses , tend  ernes or vaginal discharge.                                                                                                                                                                                  b\The combined oral contraceptive pills is the first line of contraception but in her case is contraindicted because of high BMI [42kg/m2] ,together as patch and vaginal ring  . progesterone only pill and injectable medroxiprogestroe asetate increase the weight . so not use in  her case .   The intrauterine system IUS Mirena is the best choice but it mayy lead to intermenstrual bleeding in the first 3-6 months .                                                    c\ In her condition the use of intra uterine contraceptive device of copper is a good option together with the IUS but tht it may cause infection , intermenstrual bleeding   , expulsin and if pregancy occur can cause ectopic pregnancy  , but is lead to decrease menses loss  cost effective and use for 5 years is sometime reasurring  .