Table 2.

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If the goal is to achieve amenorrhea, the OCP can be given continuously, but is usually withdrawn every 3 to 4 months to allow endometrial shedding and avoid irregular bleeding.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.
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
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.