Gynecology Book

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Oral Contraceptive Side Effect Management

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  1. See Also
    1. Oral Contraceptive-Related Uterine Bleeding Management
    2. Oral Contraceptive Selection
    3. Oral Contraceptive
  2. Management: Nausea
    1. Take pill at bedtime, or at a meal
    2. Use Low Estrogen pill (e.g. Loestrin 1/20)
  3. Management: Fluid Retention
    1. Change to OCP with the following characteristics
      1. Low Estrogenic Activity (or low Estrogen dose)
    2. Examples
      1. Loestrin 1/20
      2. Loestrin 1.5/30
  4. Management: Appetite too active or weight gain
    1. Change to OCP with the following characteristics
      1. Low Estrogenic Activity (or low Estrogen dose)
      2. Low Androgenic Activity
    2. Examples
      1. Ovcon 35
      2. Ortho Novum 1/35
  5. Management: Hypertension
    1. Discontinue Oral Contraceptive
    2. Consider Mini-Pill (Progestin only)
  6. Management: Major Depression
    1. See Major Depression Management
    2. Change to OCP with the following characteristics
      1. Low Progestin Activity
    3. Adjunctive Measures
      1. Pyridoxine 20 mg bid
  7. Management: Migraine Headaches
    1. See Also Menstrual Migraine
    2. Change to OCP with the following characteristics
      1. Low Estrogenic Activity (or low Estrogen dose)
    3. Examples
      1. Loestrin 1/20
      2. Progesterone only OCP
      3. Avoid triphasic Oral Contraceptives
      4. Continuous Cycle (84 days OCP with 5 days withdraw)
        1. Indicated for Menstrual Migraine
  8. Management: Miscellaneous adverse effects
    1. Decreased Libido
      1. Increase Androgenic Activity
    2. Moodiness
      1. Lower Estrogenic Activity
    3. Dry Eyes
      1. Increase Progestin Activity (Progestin dominant pill)
  9. References
    1. Cerel-Suhl (1999) Am Fam Physician 60(7):2073
    2. Speroff (1993) Obstet Gynecol 81:1034
    3. Dickey (1998) Managing Contraceptive Pill Patients

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