The patient Sandra is a 33-year-old woman who moved to the US from Canada with her family five years ago. She has been married for 10 years and has two children: a 10-year-old daughter from her first marriage and a 7-year-old son from the second one. In the current relationship, neither she, nor her husband want to have more children. Since she gave birth to her son, Sandra has been struggling to control her weight and is very nervous about the potential possibility to gain it from various types of hormonal contraception.
Since the decision not to have children any more five years ago, Sandra has changed the contraceptive methods. For some time, she used oral contraceptive pills that needed to be taken daily during the regular cycle. Altavera (ethinyl estradiol 30 mcg/levonorgestrel 0.15 mg) was used as the contraception method based on progestin and estrogen work. However, such side effects as nausea, vomiting, headache and the raise of the blood pressure to 130/90 mmHg were observed. The symptoms were not continuous. Sandra had several episodes of a persistent headache that was associated with the intake of the new pill. However, it did not occur each time when the pill was taken. Moreover, the last time as she took the pill she felt dizziness and had trouble breathing. As a result, the allergic reaction was diagnosed and the contraception method was changed for NuvaRing. It is important that neither the family nor personal medical history have any cases of diabetes, migraines, blood clots, cardiovascular diseases or cancer. Besides, Sandra does not use any other medicines. After Altavera usage, she has gained weight, and her BMI has increased from 26 kg/m2 to 30 kg/m2. She is also not a smoker.
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In two months after the contraception method was changed, Sandra felt nausea and dizziness. However, with regard to the previous experience, she was convinced that these were the side effects of the hormonal contraception and was not in a hurry to consult the physician at once. She was delivered to the hospital after she fainted in the street. At the hospital she confessed that she had been feeling the slight weakness and fatigue for nearly a month.
The life mode of the woman did not change during 2 months. However, she confessed that after she gained weight, she started smoking from time to time even though she was aware that smoking was not compliant with NuvaRing contraception she used. She also had a one-month menstruation interval, but she was aware that such interval could be normal in case of the hormonal contraception usage. The feeling that the breasts seemed swollen or sore were also considered by the patient as a reaction to the new contraception method.
The physical examination did not show any deviation from the norm but for the lowered systolic blood pressure of 110/70 mmHg. The pelvic examination did not reveal any signs of abnormal conditions either.
Lab and Diagnostic Studies
The blood, urinary tests and ultrasonography has confirmed the pregnancy of the small term. The laboratory tests needing cytotrophoblast and syncytiotrophoblast hormones examination were made. The transvaginal ultrasonography and transabdominal ultrasonography were used to identify the pregnancy, risks and gestational age.
The initial diagnosis was either side the effects from NuvaRing or pregnancy. The diagnosis was limited to pregnancy of the early term right after the blood, urine tests and ultrasonography. NuvaRing is not used during pregnancy. Therefore, it must be removed immediately. Finally, with regard to the previous plans, the patient has to make a choice regarding the further pregnancy or abortion.
NuvaRing is the effective contraception means that decreases the chance to get pregnant to 0,7% per year. In the majority of cases, it is the best method of contraception as it allows a woman to forget about the pills intake and has to be changed only once per 3 weeks. Moreover, consisting of etonogestrel and ethinylestradio it is rapidly absorbed in the tissues. The transition from pills to the ring is also quite easy, but needs to be correct and accurately followed.
Even though the method is effective, the patient made a mistake and did not ensure the input of the ring the next day after she stopped the intake of the pills. The hormones of Sandra have obviously got to the norm in the gap period and the sexual intercourse has led to pregnancy. Moreover, the gain loss became the additional risky factor to get pregnant.
The Relevance of the Case and Its Special Features
The major characteristics of the case include the poor awareness of the patient about the necessity to follow the contraception pills-ring transition carefully. Moreover, the previous experience has become confusing and made Sandra unaware that she was pregnant. Overall, in some cases, it is true that the early terms of pregnancy can be seen similar to the side effects from the hormonal contraception as both of the conditions are associated with the change in the hormones level.
Contraception choice was predetermined by the fact that the return to fertility after the hormonal contraception usage can be immediate. The hormones from NuvaRing are absorbed very rapidly. Moreover, it is very convenient because there is no need to take pills daily. The only regular action that is demanded is the ring change in a 3-week period.
The patients condition was quite ambiguous due to her previous experience with the hormonal contraception and symptoms. However, with regard to the laboratory investigations and examination, it became clear that the pregnancy caused by the incorrect control methods usage and transition from pills to a vaginal ring in particular. The case is important to emphasize that the proper awareness and instructions are the basic ways to control pregnancy and ensure the best effects of the contraception.
To conclude, one should emphasize that unintended pregnancy can occur when females change the birth control methods but are not aware of how to do it correctly. In order to prevent the possible gaps in contraception, it is necessary to remembering the doses and periods and adhere to all rules. In case of any inconsistencies or suspicions, it is obligatory to consult the physician and get the accurate advice. Although the transition from pills to the vaginal ring does not require the overlap method, it is advisable to start the ring usage the next day after the pill was last taken. Otherwise, the hormones will increase to the level that will permit pregnancy. The hormones from the NuvaRing are absorbed quite rapidly. However, in Sandras case, with regard to the long period after the pills intake, and before the NuvaRing usage, it was desirable to use condoms or spermicide for the sexual intercourse. In fact, the longer is the contraception-free interval, the higher the possibility to get pregnant becomes.