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13 - Contraceptionin the 40-somethings

Published online by Cambridge University Press:  05 August 2013

Paula Briggs
Affiliation:
Southport and Ormskirk Hospital NHS Trust
Gabor Kovacs
Affiliation:
Monash University, Victoria
John Guillebaud
Affiliation:
University College London
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Summary

This chapter presents a case study of a 42 year old female (Alison), who suffered from heavy painful periods. Alison's situation is far from unusual for this age group, where the risk of relationship breakdown is high. It is apparent that Alison's first priority is a highly effective contraceptive method. However, she requires much more from her method: effective control of bleeding and dysmenorrhoea; restoration of menstrual predictability and/or amenorrhoea. A bimanual examination for Alison is undertaken to assess for uterine enlargement (fibroids, adenomyosis), uterine mobility and adnexal masses and/or tenderness. Alison was advised about how the levonorgestrel-releasing intrauterine system (LNG-IUS) works by profound endometrial glandular and stromal suppression, cervical mucus changes and a foreign body effect within the endometrium. Progestogen-only pills (POPs) would be an option for Alison if she has contraindications to taking oestrogens.
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Information
Contraception
A Casebook from Menarche to Menopause
, pp. 111 - 119
Publisher: Cambridge University Press
Print publication year: 2013

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