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Gynecology

An 18-year-old presents to primary clinic to discuss starting combined hormonal contraceptives (CHCs) for pregnancy prevention. She has a history of migraines with aura, breast fibroadenoma, and well-controlled type 1 diabetes. Her family history is positive for a mother and grandmother with breast cancer. She has not yet undergone testing for this mutation. Which of the following is a contraindication to combined hormonal contraceptives?

A. Migraines with aura

B. Breast fibroadenoma

C. Type 1 diabetes

D. Family history of breast cancer

Answer: A

Absolute contraindications for combined hormonal contraceptives (CHCs) include migraine with aura, uncontrolled hypertension, hepatocellular disease, and personal history of breast or liver cancer. Fibroadenoma development may be reduced by 1 to 2 years of CHC use and is not a contraindication to starting CHCs. Well-controlled type 1 diabetes and a family history of breast cancer are not contraindications for CHC use.

References: Upadhya KK. Contraception for adolescents. Pediatr Rev. 2013;34(9):384-394. Pubmed ID: 24000342.

Nickles MC, Alderman E. Noncontraceptive use of contraceptive agents. Pediatr Rev. 2014;35(6):229-242. Pubmed ID: 24891597.

A 25-year-old woman is diagnosed with pelvic inflammatory disease (PID) during a clinic visit. She is interested in getting an intrauterine device (IUD) to prevent pregnancy as soon as possible. After completing treatment for PID, when is the soonest she can have an IUD placed?

A. 48 hours

B. 2 weeks

C. 3 months

D. 1 year

Answer: C

An IUD should not be placed if a patient has had PID within the last 3 months, so she may have an IUD placed after 3 months.

Reference: Upadhya KK. Contraception for adolescents. Pediatr Rev. 2013;34(9):384-394. Pubmed ID: 24000342.

Which of the following is first-line treatment for primary dysmenorrhea?

A. Combination estrogen and progesterone oral contraceptives

B. Non-steroidal anti-inflammatory drugs

C. Progesterone-only oral contraceptives

D. Levonorgestrel-releasing intrauterine system

Answer: B

Primary dysmenorrhea is the crampy, suprapubic pain that occurs just before menses and may last for several days. Secondary dysmenorrhea is the pelvic pain associated with another condition such as endometriosis or adenomyosis. First-line treatment for primary dysmenorrhea is non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen. ...

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