Oral Contraceptive Side Effect Management

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 Headache
   1. See Also Menstrual Migraine
   2. Do not use Oral Contraceptives in women who have Migraine with Aura (risk of stroke)
   3. Characteristics
      1. More common during the first cycle of Oral Contraceptives
      2. More common in women over age 35 years
   4. Management: General
      1. Change to OCP with low Estrogenic Activity (or low Estrogen dose)
      2. Examples
         1. Loestrin 1/20
         2. Progesterone only OCP
         3. Avoid triphasic Oral Contraceptives
         4. Continuous Cycle or Seasonal Contraception (84 days OCP with 5 days withdraw)
            1. Indicated for Menstrual Migraine
   5. Management: Headache during the Placebo week
      1. Take estradiol 10 mcg orally for 5 of the 7 Placebo days
      2. Benefit in age over 40 years (unclear if benefit extends to younger women)
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 81:1034-47
   3. Dickey (1998) Managing Contraceptive Pill Patients