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Vital signs
Current medications
Selection Rationale
A. VIABLE OPTION. Previously, providers had no guidance for managing women
with inflammatory bowel disease (IBD) who require contraception. The US MEC
includes IBD (ulcerative colitis, Crohns disease) as a medical condition associated
with increased risk in some circumstances [SLIDE 8].5 The use of COCs/patch/ring is
assigned a category of 2 for mild IBD and 3 for IBD with venous thromboembolism
risk (ie, active or extensive disease, surgery, immobilization, corticosteroid use,
vitamin deficiencies, fluid depletion). Megans disease is mild and her condition is,
therefore, a category 2 risk. If she had more severe disease, this option would not be
appropriate.
B. VIABLE OPTION. The presence of mild IBD gives POPs and DMPA injection a
US MEC category of 2 for Megan; therefore, the advantages of these methods
generally outweigh the theoretical or proven risks.
Case (contd)
Megan is presented with all of the above contraceptive options. After risks and
benefits of each option are considered, Megan selects the LNG-IUD because she is
comfortable using the copper IUD but would like a method that lightens her bleeding
and a method that is more forgettable. She is prescribed a LNG-IUD. At her 1-year
follow-up visit, she reports that her periods have become much lighter and she has no
discernable side effects from using this method. Megans last ulcerative colitis flareup was approximately 6 months ago
Selection Rationale
A. CORRECT. Use of the LNG-IUD may be considered to reduce heavy menstrual
bleeding11 and therefore should help to lighten Megans heavier periods.
C. CORRECT. The incidence of endometrial cancer is reduced with use of an LNGIUD [SLIDE 9].
Case Summary
Because Megan has only mild IBD, there are no restrictions regarding contraceptive
choice. Most contraceptive methods offer noncontraceptive benefits; Megans use of
the LNG-IUD will help provide lighter periods. The LNG-IUD has also been shown
to reduce risk of endometrial cancer and pelvic inflammatory disease (PID).11-13