Case of the Month ESAP Special Edition: Women’s Health

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This issue highlights a special edition of ESAP, available for a limited time. Test your clinical knowledge with this free case to discover the rich intellectual legacy of endocrinology. Available on the online store.

Clinical Vignette

A 38-year-old woman is seeking your opinion on whether she is a suitable candidate for restarting combined oral contraceptives containing both estrogenic and progestational agents. In her late teens, she began taking birth control pills for contraception without difficulty, but she stopped them when she and her husband wished to have children. Between pregnancies, she used barrier methods for contraception. She delivered her second daughter 3 months ago. She had a recent conversation with her primary care physician who is opposed to restarting birth control pills; thus, she is seeking a second opinion.

Her most recent pregnancy was complicated by hypertension treated with hydralazine. Her hypertension persisted after delivery and her regimen was switched to metoprolol, which she continues to take at a dosage of 50 mg twice daily. This is her only medication. Otherwise, it was an unremarkable pregnancy with delivery of a healthy, full-term baby. She is not breastfeeding.

Her medical history is unremarkable. She has resumed smoking cigarettes in the past month (1 pack per day), although she had stopped smoking during the pregnancy. She is relatively active. There is no personal or family history of deep venous thrombosis.

On physical examination, her height is 63 in (160 cm) and weight is 161 lb (73.2 kg) (BMI = 28.5 kg/m2). Her blood pressure is 126/78 mm Hg, and pulse rate is 66 beats/min. She has normal findings on cardiovascular and pulmonary examination. On her extremities, she has extensive bilateral venous varicosities without pedal edema. Arterial examination findings are normal.

You agree with her primary care physician that an alternative method of contraception should be selected.

Which of the following characteristics of this patient provides the strongest rationale for that opinion?

  1. Current smoker
  2. Hypertension
  3. BMI ≥25 kg/m2
  4. Venous varicosities
  5. Postpartum status


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