Oral Contraceptive Pill
| Combination Oral Contraceptive Pill |
| If the goal is to achieve amenorrhea, the OCP can be given continuously, but is usually withdrawn every 3 to 4 months to allow endometrial shedding and avoid irregular bleeding. |
| Irregular bleeding |
| In most women, suspect a thin endometrium and cycle on OCP (eg, Necon 1/35) for at least 3 months. If PCOS is suspected (ie, thick endometrium), consider cyclic progestin (Table 3), and then continue cyclic progestin or switch to OCP. |
| If there is heavy bleeding at the time of the visit, start a moderate-estrogen OCP (eg, LoOvral) one active pill QID × 4 days, then one TID × 3 days, then one BID × 2 days, then daily × 3 weeks, then skip 1 week, then cycle on OCP for at least 3 months. |
| Menorrhagia |
| Can start OCP any time but typically on Sunday following first day of menses. |
| Contraindications to OCP |
| Previous thromboembolic event or stroke |
| History of estrogen-dependent tumor |
| Active liver disease |
| Pregnancy |
| Hypertriglyceridemia |
| Older than 35 years and smokes >15 cigarettes per day |
| Older than 40 years is not a contraindication but many physicians favor progestin for this age group. |