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Supporting patients to choose appropriate contraception

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Leanna is a 17 year old young woman who attends clinic to discuss contraception. She lives with her mother and siblings in a flat and is taking a further education course in childcare; she attends college regularly.

Leanna has been with her partner who is 18 years old for one year. She appears very concerned that she might be pregnant as, although she is on the combined oral contraceptive pill, she keeps forgetting to take it. She complains that she has been feeling very 'moody' since she has been taking the pill and has had some breakthrough bleeding.

A full history is taken from Leanna. This incorporates medical, family, sexual, obstetric and menstrual history as well as a discussion of other health issues such as smoking, drinking alcohol and drug taking.

Leanna has no significant health issues apart from mild asthma and she uses inhalers sporadically to ease this. Members of her immediate family have no significant health issues. She has been with her partner for a year and has had no other partners during this time but is unsure of his fidelity.

She has had five previous male partners and has not had any sexual health screening for the past two years. She had a surgical termination of pregnancy three months ago and was started on the combined pill after the termination of pregnancy. Before the termination, she had only ever used condoms and then sporadically.

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