Adolescent Wanting to Start Contraceptive Pill — Free SCA Practice Case
Adolescent wanting to start contraceptive pill
Station Timer
Golden Minute
Initial Introduction
•Introduce yourself
•Ask an open question — "How can I help you today?"
•Listen — don't interrupt
•Catch early cues
Data Gathering
History, ICE & Diagnosis
Clinical Management
Diagnosis, Plan & Decisions
Safety Net
Follow-up & Close
Five cases are free: a live 12-minute consultation with an AI patient each, marked, and no card.
Materials for Candidate
Please review before starting the consultation
Full Name
Maya Gupta
Age
15 years
Consultation Type
TelephoneAge
15
Past Medical History
- ●Mild Asthma (Step 1).
- ●Dysmenorrhea (Painful periods).
- ●History of mild Acne.
Medication History
- ●Salbutamol 100mcg inhaler (as required)
- ●Ibuprofen 400mg TDS (during menses)
- ●NKDA
Recent Medical Notes
- ●12th Dec 2025: Attended with mother. Complained of "severe" period pain and heavy flow causing her to miss school. Menstrual diary requested. Ibuprofen and heat pads advised.
- ●Current Date: Self-booked telephone appointment.
- ●Reason for Encounter: "Wants to discuss starting the pill."
- ●Last BP/BMI: Height 158cm, Weight 49kg (BMI 19.6). Recorded 18 months ago.
Patient Script
For the friend playing the patient role
Character Overview: You are Maya, 15. You are calling from your bedroom. You are trying to sound decisive and "grown-up," but you are secretly very anxious about the legalities of this call.
Opening Sentence: "Hi Doctor, I'm calling because I've been thinking about what we discussed with my mum a few months ago, and I think I'm ready to start the contraceptive pill now to help with my periods."
A. History if Asked (Data Gathering Phase)
- ●The Hidden Agenda: You have a boyfriend, Leo (18). You have not had sex yet, but you have discussed it and both feel ready. You want the pill for contraception, but you are using the "painful periods" as a medical cover because it feels safer.
- ●The Relationship (Leo): He is 18 and an apprentice at a local garage. You have been together for 5 months. He is not "pushy"—he actually told you to check with a doctor first. He doesn't go to your school.
- ●The Headaches: You get a dull, thumping headache on day 1 of your period. It makes you feel slightly sick. Crucial: You have never had flashing lights, zig-zags, numbness, or "weird" vision before or during the headache.
- ●Confidentiality Barrier: Your mother is a receptionist at a GP surgery in the next town. You are convinced that because it's the same "system," she will see your name on a list or see a prescription pop up. You need explicit reassurance on how this works.
- ●Forgetfulness Barrier: You work at a local dog kennel on Saturday and Sunday mornings. You have to be there by 7:00 AM. You usually wake up late, rush out the door without breakfast, and often forget your inhaler. You have never had to take a daily pill before.
ICE — Ideas, Concerns, Expectations
The patient does not volunteer these unprompted. They surface only when the candidate directly explores the patient's perspective.
- ●Ideas: You think the pill is the obvious solution because it's what everyone talks about and your friend's older sister went on it at your age. You've seen a lot of information on TikTok and Instagram, some of which has worried you. You don't fully understand the difference between the various types of contraception — to you, "the pill" is the only real option.
- ●Concerns: You are worried the doctor will refuse to see you without your mum, or that your mum will somehow find out through the GP system. You are also anxious about side effects — particularly weight gain and acne — because you already feel self-conscious about your skin. Underneath it all, you are nervous about whether what you and Leo are planning is "okay" given he is 18 and you are 15.
- ●Expectations: You want the doctor to give you a prescription for the pill today, reassure you that your mum won't find out, and tell you it's safe. You are hoping for a straightforward, quick conversation — you don't want to be lectured or made to feel like you're doing something wrong.
If Asked — Medical History and Medications
The patient provides this information only if directly asked by the candidate.
- ●Asthma: "It's really mild — I hardly ever use my inhaler. Maybe if I'm running in PE when it's cold, but honestly I forget to bring it most of the time. I haven't had an asthma attack or anything like that."
- ●Salbutamol inhaler: "I've got a blue one somewhere in my bag. I don't use it regularly — just if I get a bit wheezy, which isn't often."
- ●Period pain (Dysmenorrhea): "It's been bad since they started, maybe two years ago. Day one and two are the worst — it's like a really deep cramping in my lower tummy. Sometimes I can't even get out of bed. The ibuprofen helps a bit but doesn't get rid of it completely."
- ●Ibuprofen: "I take it when my period starts — three times a day like it says. It takes the edge off, but I still feel pretty rough. I tried paracetamol too but it didn't do much."
- ●Acne: "I get spots on my chin and forehead, mostly around my period. I've tried a few face washes from Boots but nothing really works. It's not massive but it makes me feel rubbish."
- ●Previous GP visit (December): "Yeah, I came with my mum. The doctor said to keep a diary of my periods and use ibuprofen and a hot water bottle. I did the diary for a bit but then forgot. That's sort of why I'm calling now — it's still bad and I want something that actually works."
- ●Allergies: "No, I'm not allergic to anything that I know of."
Social History and Lifestyle Impact
This information is volunteered naturally in conversation, not delivered as a monologue. Integrate with the character overview and existing tone.
- ●School: You are in Year 10 at a local comprehensive. You are predicted good GCSEs and want to do well, but your periods have caused you to miss at least one or two days a month. You've had to leave lessons to go to the school nurse and it's embarrassing — especially in front of boys in your class.
- ●Kennel job: You work Saturday and Sunday mornings at a local dog kennel, 7 AM starts. You love it and it's your first proper job — you get paid cash and it makes you feel independent. But when your period is bad on a weekend, you've had to call in sick twice and you're worried the owner will stop giving you shifts.
- ●Impact on daily life: "I missed two days of school last month because of my period. I couldn't even sit in a chair properly — I was just curled up with a hot water bottle. And I had to call in sick to the kennels on a Saturday, which was really embarrassing because I'd only just started. I can't keep doing this every month."
- ●Home life: You live with your mum and younger brother (12). Your parents separated two years ago. Your dad lives nearby and you see him every other weekend. Your mum is supportive generally but you feel she would "freak out" if she knew about Leo and the real reason for wanting the pill.
If Asked — Associated Symptoms
The patient provides these answers only when directly asked by the candidate.
- ●If asked about how heavy the periods are: "They're pretty heavy on day one and two — I have to use the big pads and sometimes I leak through at school, which is mortifying. I don't think I've ever had clots though."
- ●If asked about how regular the periods are: "They're fairly regular now — every 28 to 30 days, give or take. They were a bit all over the place when they first started but they've settled down."
- ●If asked about bleeding between periods (intermenstrual bleeding): "No, nothing like that — it's just during my actual period."
- ●If asked about any vaginal discharge: "No, nothing unusual."
- ●If asked about mood changes around periods: "I do get quite moody and tearful the day before — my mum says I'm a nightmare. But it passes once my period starts."
- ●If asked about bloating or breast tenderness: "Yeah, my boobs get a bit sore before my period and I feel a bit bloated, but it's not that bad."
- ●If asked about nausea or vomiting with periods: "I feel a bit sick on day one, especially when the headache is bad, but I've never actually been sick."
- ●If asked about any leg pain, swelling, or breathlessness: "No, nothing like that."
- ●If asked about family history of blood clots or DVT: "Not that I know of. No one in my family has had anything like that."
- ●If asked about family history of breast cancer: "No, I don't think so."
- ●If asked about family history of migraines: "My mum gets headaches but I don't think she gets the flashy light things — she just takes paracetamol and carries on."
- ●If asked about smoking: "No, I've never smoked."
- ●If asked about alcohol or drugs: "I've had a few sips of cider at a party but I don't really drink. No drugs or anything."
- ●If asked about fainting or dizziness with periods: "No, I don't faint or anything. I just feel a bit rubbish."
- ●If asked about any sexually transmitted infection symptoms: "No, we haven't actually done anything yet, so no."
- ●If asked about whether Leo has had previous sexual partners: "I think he had a girlfriend before me, but I don't really know the details. He said he's been tested but I'm not sure what for."
B. Responses to Management (The Negotiation Phase)
- ●
If the Doctor suggests the Combined Pill (COC):
- ●Reaction: Positive initially, but then express concern: "I saw a video on TikTok saying the pill causes permanent infertility and can make you gain 2 stone. Is that true?"
- ●Compliance: If they don't mention your kennel job, say: "If I miss a day because I'm rushing to work, is that a big deal?"
- ●
If the Doctor suggests LARC (The Implant):
- ●Reaction: Hesitant. "A few girls at school have that, but they said it makes your skin break out in spots. My skin is already bad enough. Does it cause acne?"
- ●
If the Doctor suggests the Injection (Depo):
- ●Reaction: Strong negative. "I've heard that one makes you put on loads of weight, and I'm really scared of needles."
- ●
If the Doctor asks to speak to your Mum:
- ●Reaction: Firm refusal. "No. If you have to tell her, then I just won't do it. I'll just have to deal with the periods."
- ●
If the Doctor discusses STIs/Condoms:
- ●Reaction: "Leo said he'd use them, but I thought if I was on the pill, we didn't need to?" (This tests the doctor's ability to explain "Double Protection").
Mark Scheme
Domain 1: Data Gathering and Diagnosis
Domain 2: Clinical Management and Medical Complexity
Domain 3: Relating to Others
Clinical Learning Points
The Legal Framework — Fraser Competence
To provide contraceptive advice or treatment to a person under 16 without parental consent, the Fraser guidelines require you to be satisfied that all five criteria are met:
- ●The young person understands the advice being given.
- ●You cannot persuade them to inform a parent or carer, or it is not in their best interests to do so.
- ●They are likely to begin or continue having sexual intercourse with or without contraceptive treatment.
- ●Without contraceptive advice or treatment, their physical or mental health (or both) are likely to suffer.
- ●Their best interests require them to receive contraceptive advice or treatment with or without parental consent.
- ●Fraser applies specifically to contraceptive provision in under-16s. Gillick competence is the broader principle underpinning a young person's capacity to consent to medical treatment generally — the two are related but distinct.
- ●Document your Fraser assessment explicitly in the notes. This is both good clinical practice and essential medicolegal protection.
UKMEC Categories and This Case
The UK Medical Eligibility Criteria (UKMEC) classifies contraceptive methods by safety for individual patients:
- ●UKMEC 1 — no restriction; method can be used
- ●UKMEC 2 — benefits generally outweigh risks; method can be used
- ●UKMEC 3 — risks generally outweigh benefits; usually not recommended
- ●UKMEC 4 — unacceptable health risk; method must not be used
Maya's classification:
- ●Combined oral contraceptive (COC): UKMEC 2 for age under 40, BMI 19.6, and migraine without aura. The benefits outweigh the risks — the COC is not contraindicated.
- ●Progestogen-only implant (Nexplanon): UKMEC 1 — no restrictions apply.
The critical migraine distinction:
- ●Migraine without aura → UKMEC 2 for COC (usable)
- ●Migraine with aura → UKMEC 4 for COC (absolutely contraindicated — significantly elevated ischaemic stroke risk)
Always screen for aura features specifically: flashing lights, zig-zag lines (fortification spectra), scotoma, unilateral numbness or tingling, or speech disturbance. A dull menstrual headache with nausea but no focal features, as in this case, is not migraine with aura.
LARC as First-Line — and Why Lifestyle Matters
NICE CKS and FSRH guidance consistently emphasise that long-acting reversible contraception (LARC) is more effective than user-dependent methods and should be discussed proactively with all patients requesting contraception — particularly adolescents.
- ●The subdermal implant (Nexplanon) offers >99.9% efficacy, works for up to 3 years, and requires no daily action. It is the most effective reversible contraceptive available.
- ●For Maya specifically — early-morning weekend shifts, rushed mornings without breakfast, a history of forgetting her inhaler — adherence to a daily pill will be genuinely challenging. The implant addresses this directly.
- ●The progestogen-only pill (POP/desogestrel) has a 12-hour missed-pill window (vs. 24 hours for traditional POP), but still requires daily consistency — less suitable for this patient's pattern.
- ●Do not present LARC as a second resort. FSRH guidance frames it as a positive first-line option for most patients, not a fallback when the pill seems impractical.
Implant and acne: Progestogen-only methods can worsen acne in some users due to androgenic activity. This is a real concern for Maya and should be acknowledged honestly rather than minimised. Weigh against the substantial efficacy advantage and discuss openly as part of shared decision-making.
COC Use in Dysmenorrhoea — Regimen Matters
Where the combined pill is chosen, it confers genuine therapeutic benefit beyond contraception:
- ●Dysmenorrhoea: The COC is a first-line pharmacological option for primary dysmenorrhoea unresponsive to NSAIDs (NICE CKS). It reduces endometrial prostaglandin production, directly reducing cramping.
- ●Acne: COCs with low androgenic progestogen activity (e.g., ethinylestradiol/norgestimate, ethinylestradiol/drospirenone) have evidence for improving acne — a secondary benefit relevant to Maya.
- ●Regimen: For dysmenorrhoea, offer a continuous or extended (tricycling) regimen rather than defaulting to the standard 21/7 pattern. Continuous use eliminates or substantially reduces withdrawal bleeds, maximising symptom relief. This is the most clinically meaningful prescribing decision for this presentation and is specifically supported by FSRH and NICE CKS.
First-line COC choice: A second-generation COC (e.g., levonorgestrel/ethinylestradiol) is standard first-line. Third-generation or anti-androgenic options (e.g., drospirenone) may be appropriate if acne benefit is a priority, but carry marginally higher VTE risk — discuss trade-offs with the patient.
Depo-Provera in Adolescents — A Specific Caution
FSRH advises that Depo-Provera (medroxyprogesterone acetate injection) should not generally be used as first-line contraception in under-18s due to its association with reduced bone mineral density (BMD) during a period of critical bone accrual. Adolescence is the peak window for bone development, and suppression of oestrogen by high-dose progestogen has a measurable impact on BMD.
- ●This is not an absolute contraindication — Depo can be used when other methods are contraindicated or unacceptable — but it requires explicit discussion of the bone density risk.
- ●The injection's irreversibility (effective for 12–14 weeks once given) also warrants particular caution in a first-time user who may not tolerate it.
Addressing Social Media Misconceptions
Two specific TikTok-derived beliefs require direct, evidence-based correction:
- ●"The pill causes permanent infertility": False. Fertility returns promptly after stopping hormonal contraception. There is no evidence of long-term impact on fertility. Some women experience a short delay in return of ovulation after stopping the COC, but this is temporary and does not affect overall reproductive outcomes.
- ●"The pill causes significant weight gain": NICE CKS and a large Cochrane review find no evidence of a causal link between the COC and clinically significant weight gain. Minor fluid retention in the early months may occur for some users, but this is not equivalent to lasting weight change.
Do not dismiss these concerns as "internet misinformation" without engaging with the specific worry. Acknowledge that these beliefs are widespread, then correct them clearly with the evidence.
Double Protection — STI Prevention
Hormonal contraception provides no protection against sexually transmitted infections. This is a critical patient education point, particularly for a 15-year-old beginning sexual activity.
- ●Explain the principle of dual protection: a reliable hormonal method for pregnancy prevention combined with consistent condom use for STI prevention.
- ●Address Maya's misconception directly — being "on the pill" does not replace condoms.
- ●Leo's sexual history is relevant: he has had a previous partner and Maya is unsure of his STI status. This makes STI risk real and worth addressing practically, not hypothetically.
- ●Signpost confidential, age-appropriate services: Brook (brook.org.uk) offers free, confidential sexual health advice, testing, and contraception for under-25s. The C-Card scheme provides free condoms to young people via local pharmacies, youth services, and sexual health clinics without a GP referral.
Confidentiality and GP Records
Maya's concern that her mother — a receptionist at a nearby GP practice — will see her record through "the system" is a genuine and understandable barrier to care. Address it specifically:
- ●GP records are held at practice level and are not visible to staff at other practices, including neighbouring surgeries on the same clinical system.
- ●Access to patient records within a practice is controlled and audited. Receptionists can only access records for legitimate, work-related reasons — browsing a family member's record constitutes a data protection breach and would be traceable.
- ●Confidentiality would only be breached in exceptional circumstances where there is a serious, identified safeguarding risk — and this would be discussed with Maya first wherever possible.
- ●A brief, clear explanation of this at the start of the consultation removes a significant barrier and helps Maya engage openly.
Safeguarding — The Age Gap
The three-year age gap between Maya (15) and Leo (18) does not automatically constitute a safeguarding concern, but it warrants structured assessment:
- ●Under the Sexual Offences Act 2003, sexual activity between a 15-year-old and an 18-year-old is technically unlawful, even if apparently consensual. This does not mean automatic referral, but it must be considered.
- ●The clinical task is to assess whether the relationship is genuinely consensual and free from coercion, exploitation, or undue pressure. Ask directly and sensitively: does she feel safe, is Leo ever pushy, does she feel she can say no, who makes decisions in the relationship?
- ●In this case, the script indicates Leo is supportive, not coercive — but this assessment must be made explicitly and documented.
- ●Familiarise yourself with your practice's safeguarding lead and local LSCP (Local Safeguarding Children Partnership) threshold guidance for age-disparate relationships in adolescents.
Baseline Observations and Safe Prescribing
The COC should not be initiated without a blood pressure measurement. BMI is also required for UKMEC classification (though Maya's recorded BMI is within normal range).
- ●On a telephone consultation, arrange a brief face-to-face or nurse appointment for BP and weight before issuing the prescription, or advise a pharmacy BP check and request the reading before prescribing.
- ●Issue an initial 3-month supply for new starters (FSRH guidance). This allows early review of tolerability, side effects, and ongoing suitability before committing to a longer prescription.
- ●A 3-month follow-up review should be arranged at initiation, covering: BP recheck, acne and mood, adherence pattern, any side effects, and continued suitability of the chosen method.
Safety Netting
Specific symptoms requiring urgent review if Maya starts the COC:
- ●Sudden severe headache — particularly if different in character from her usual menstrual headache
- ●Visual disturbance — blurred vision, sudden loss of vision, or new onset of visual aura
- ●Unilateral leg pain or swelling — possible DVT
- ●Chest pain or breathlessness — possible PE
- ●Severe abdominal pain
These represent potential thromboembolic or cerebrovascular events. Maya should know to call 999 or attend A&E — not wait for a GP appointment — if these occur.
Reassure her that these events are rare in a healthy 15-year-old with no risk factors, but that knowing the warning signs is part of using the method safely.
Mapped to the RCGP curriculum topic: Patient < 19 years old.
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