Teaching
Case 7: Contraceptive Encounters

Session Objectives

Students will be able to:
  • Describe how hormonal birth control works
  • Describe which hormonal birth control methods are appropriate for different cases
  • Describe recent advances in pharmaceuticals for birth control
In this session students will consider several scenarios between medical doctors and patients, and describe the doctor's best response to the patients' questions and concerns. Students will either write or act out in class their carefully constructed responses.

Scenario 1

A young doctor in general practice sees a 17 year old girl who comes in with her mother. He notes in her file the mother's report that the young woman is not sexually active (and examination shows no reason to doubt this) but is having irregular cycles and menstrual discomfort. During the exam, when the mother is in the waiting room, the young woman says she heard that taking the pill can relieve her symptoms and cure her acne. What does he tell her about this claim, and what does he recommend for her treatment?

ethinyl estradiol
CAPTION: Ethinyl Estradiol is the most common orally active artificial estrogen in use. (click image for 3-D interactive animation) CREDIT: ChemIDPlus, National Library of Medicine


Scenario 2

A woman in her early 40's comes to the office of her gynecologist. She is worried that she might get pregnant, and that at her age there would be complications, so she wants to start taking birth control. Her gynecologist, who studied at Tulane and did her residency at Hopkins, wants to present options to her patient. She knows that it is best to let patients choose, but that they may have trouble making sense of their options because they don't necessarily understand their own biology, have little knowledge of chemistry, and be confused by the claims of pharmaceutical ads. Another factor she wants to consider is this woman's age, and to make a wise choice of dose and drug based upon that information. What options does she present to her patient, and what are her recommendations?

progesterone
CAPTION: Progesterone is naturally synthesized hormone used in many pharmaceutical contraceptives (click image for 3-D interactive animation) CREDIT: ChemIDPlus, National Library of Medicine



Scenario 3

A young college student comes in to the student health center on campus. She had an unplanned and unprotected sexual encounter, and is concerned she might become pregnant. She has heard about the "morning after" pill but she isn't sure how it works, and what its side effects might be. What should her health provider tell her?

mifeprestone
CAPTION: Mifeprestone is an abortifacient agent commonly known as RU-486 (click image for 3-D interactive animation) CREDIT: ChemIDPlus, National Library of Medicine


Scenario 4

A general practitioner is seeing a woman of middle age, but premenopausal, in her office. The woman has heard in the news that estrogen therapy can lead to heart disease, and in one T.V. report estrogen was referred to as a carcinogen. The patient has been on the pill for decades, and is concerned that her long-term usage may lead to problems. Her doctor, sitting across the desk from her, tries to explain the situation, and to clearly explain the science behind these concerns. What does this doctor say?

18beta-estradiol
CAPTION: 17-β Estradiol is the primary female hormone (click image for 3-D interactive animation) CREDIT: ChemIDPlus, National Library of Medicine


Scenario 5

A young man, in his third year at medical school, attends a family gathering at his fiancee's house. After dinner, his future sister-in-law, who attends college out of state and is home for the weekend, corners him and peppers him with questions and complaints. "Why is birth control a woman's responsibility? Why isn't there birth control for men? If they spent all the money they used on cures for erectile dysfunction and hair loss on finding birth control for men, they would have a solution by now." As she finishes the room gets quiet, and he realizes that everyone is waiting for his, hopefully intelligent, response. What can he tell her?

testosterone
CAPTION: Testosterone is the primary male hormone (click image for 3-D interactive animation)
CREDIT: ChemIDPlus, National Library of Medicine


Case Assignment

You will work in groups to put words into these doctors' mouths. Find the answers in review articles, clinical texts, and research articles. Sparing use of reputable websites is acceptable. Make the statement clear to an intelligent person with no expertise in biology, but do not oversimplify or condescend (a good doctor would NEVER do that). Use the latest research as the foundation of your answer, and remember that examples, graphs, and pictures often help to explain complex information.


References

Risto, Erkkola 2007. Recent advances in hormonal contraception. Current Opinions in Obstetrics and Gynecology 19:547-553.