Q) A 14 year old woman has recently become sexually active and requests the combined oral contraceptive pill. Justify your management.
Contraception is important to avoid unwanted pregnancy but there is a need to ascertain if the patient is Fraser competent.
Obtain menstrual history and ask about current contraception use. This is important as patient has already commenced sexual activity, may already be pregnant if had unprotected sex.
Tactfully enquire about partner\'s age as there may legal issues regarding sexual intercourse with an under-16 year old.
Obtain medical history to exclude contraindications to COCP such as migraine with aura, strong family history of venous thromboembolism. If contraindications to COCP present, discuss alternative contraception
Check blood pressure.
Teach how to use COCP and especially regarding missed pills.
Ask if parents are aware of sexual activity. Encourage patient to inform parents, but reassure patient of confidentiality.
Arrange FU in 3 months to discuss any complications/ concerns
Other points welcomed!
Posted by Manoj M.
Does she need emergency contraception.
Sexual history, STI screen(chlamydia), GUM referral
Reminder for COCP( mobile alarm)
Alternative contraceptive choices.
Support groups(brooks)
Posted by Anjum M.
social history.discuss any other concerns. role out sexual abuse
Posted by HSPHM A.
sexual history and identify her risk for STI as Manoj pointed out - explain pills cannot prevent STI and give information about double dutch method.
