Clinical case review

A patient with heavy periods and PMS seeking contraception

Deborah Bateson, Mary Stewart




Although the primary indication for contraceptives is pregnancy prevention, some have noncontraceptive benefits that may help control symptoms associated with the menstrual cycle such as heavy menstrual bleeding. Examining the reasons for contraceptive use is important when discussing options with a patient.

Article Extract

Case scenario

Nerida is 35 years old and travels a great deal for work. She comes to see you because she wants effective oral contraception, but she also wants better control of her periods and to improve her premenstrual bloating and mood symptoms.

Nerida’s periods last for six days. On the first day of her period, she passes clots of blood the size of 50-cent pieces. She also needs to change her tampons every two hours for the first couple of days and often uses a pad as well to deal with leakage. Nerida is easily fatigued during this time, which affects her ability to do her work. She has had to take iron supplements for iron deficiency in the past. Nerida’s pelvic ultrasound shows no structural abnormality and she has no personal or family history of a bleeding disorder.