Question of the Week # 364

364)  A 28 year old woman seeks your advice regarding an effective contraception method. She is sexually active with her long term boy-friend. He has been using condoms however, he prefers not to use them on a regular basis . She tells you that she does not want to consider an Intra-Uterine Device Her past medical history is significant for Gastro-esophageal reflux disease and well- controlled Epilepsy. Her medications include omeprazole and carbamazepine.  She does not smoke. On examination, she is age appropriate with normal vitals. Physical examination including pelvic examination is normal. Which of the following contraceptive methods is most appropriate for this patient?

A) Continuous Combination Oral Contraceptive Pills

B) Cyclical Combination Oral Contraceptive Pills

C) Diaphragm with Spermicides

D) Estrogen-Progesterone vaginal ring ( Nuva-Ring)

E) Depot Medroxy Progesterone

7 Responses

  1. the answer is C

  2. E) Depot Medroxy Progesterone – has the convenience of injecting only once every 3 months and since it contains progesterone only antiepileptic drugs (carbamazepine increases estrogen metabolism) will not interfere with it its effectiveness.

    • Yes, the answer is E and explanation is perfect.
      Carbamazepine is enzyme inducer and will decrease level of oral contraceptives

  3. C.

  4. D

  5. C: because carbamazepine increases liver function so A,B,D,E, will not be as effective I believe

  6. EEE: depot medroxyprogesterone injection action is not effected by certain antiepileptic drugs. (phenytoin, carbamazepine, barbiturate)
    http://books.google.com.jm/books?id=Jm1H4EeULmYC&pg=PA401&lpg=PA401&dq=DMPA+with+carbamazepine&source=bl&ots=Ki_Xhk-3VD&sig=qr2E_xSTaLVNCcePoFn6nCZE5Cc&hl=en&sa=X&ei=NvKQUqjwEorXkQe1u4CwCg&ved=0CC0Q6AEwAjgK#v=onepage&q=DMPA%20with%20carbamazepine&f=false

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