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Oral Contraceptive-Related Uterine Bleeding Management

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  1. See Also
    1. Oral Contraceptive
    2. Oral Contraceptive Side Effect Management
    3. Abnormal Uterine Bleeding
  2. Management: Overall approach to OCP associated uterine bleeding
    1. Consider Abnormal Uterine Bleeding evaluation
    2. Evaluate for missed OCP doses
      1. Pregnancy Test
      2. Counsel on compliance
    3. Anticipate uterine bleeding in first 3 months
      1. Offer anticipatory guidance
    4. Consider adjuncts to Oral Contraceptive
      1. Ibuprofen 800 mg PO tid for 1-2 weeks
      2. Supplemental Estrogen for 1-2 weeks
        1. Premarin 0.625 to 1.25 qd
        2. Ethinyl Estradiol 20 ug qd
        3. Estradiol (Estrace) 0.5 to 1 mg qd
    5. Consider alternative Oral Contraceptive
      1. Change Progesterone type as listed below
      2. Increase Estrogen to 50 ug
  3. Management: Spotting
    1. Take pill at same time each day
    2. Evaluate if unresolved after 3 cycles of observation
      1. Missed doses
      2. Drug Interaction
      3. Abnormal Uterine Bleeding
  4. Management: Early Cycle Breakthrough Bleeding (Days 1-9) or all month
    1. OCP Characteristics
      1. Higher Estrogenic Activity
    2. Consider increasing Estrogen to 50 ug Monophasic
      1. Ovcon 50
      2. Ortho-Novum 1/50
      3. Demulen 1/50
    3. Temporarily add Estrogen prn breakthrough bleeding
      1. Ethinyl Estradiol 0.02 mg PO qd for 7 days prn
  5. Management: Late Cycle Breakthrough Bleeding (Days 10-21)
    1. OCP Characteristics
      1. Higher Progestin Activity
      2. Higher Endometrial Activity
    2. Examples
      1. Loestrin 1.5/30
      2. Loestrin 1/20
      3. Demulen 1/35
  6. Management: Menorrhagia or Dysmenorrhea
    1. OCP Characteristics
      1. Higher Progestin Activity
      2. Lower Estrogenic Activity
    2. Examples
      1. Loestrin 1.5/30
  7. Management: Amenorrhea or Menses too light
    1. Check Pregnancy Test!
    2. OCP Characteristics
      1. Lower Progestin Activity
      2. Higher Estrogenic Activity
      3. Higher Endometrial Activity
    3. Examples
      1. Loestrin 1.5/30
      2. Loestrin 1/20
      3. Demulen 1/35
    4. Consider additional Estrogen initially
      1. Premarin 0.625 mg qd for 7 days
      2. Start at beginning of next cycle
  8. References
    1. Dickey (1998) Managing Contraceptive Pill Patients
    2. Cerel-Suhl (1999) Am Fam Physician 60(7):2073
    3. Speroff (1993) Obstet Gynecol 81:1034
    4. Schrager (2002) Am Fam Physician 65(10):2073

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