case study

 A 29-year-old Caucasian female with significant bipolar disorder is treated with lamotrigine. She has a history of endometriosis. She presents with a history of heavy, irregular menses for the past 7 weeks. Patient reports that symptoms started insidiously 7 weeks ago with excessive clotting/bleeding that would last for 5 days. The pattern repeats itself every 2 weeks. Previously,
she was on a combined estrogen/progesterone oral contraceptive pill. This was stopped due to concerns of interaction with lamotrigine. She was started on a progesterone-only pill. The patient was concerned that she might be pregnant due to fatigue, nausea, and weight gain. There is no family history of ovarian, uterine, or breast cancer. Her mother has a history of thyroid cancer and type 2 diabetes mellitus. Her father has a history of hypertension. Her blood pressure is 118/75 mm Hg and her body mass index is 27.63.

A. What are the considerations of using contraceptives with individuals on mental health
medication?

B. Are certain contraceptives better in this population?

C. Are the patient’s symptoms consistent with contraceptives, her endometriosis, and/or her
mental health medications?

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