Do not prescribe oral contraceptivepills (OCPs) to females with undiagnosed vaginal bleeding
Author:
Anjali Subbaswamy, MD
What to do - Make a Decision
OCPsarewidelyavailableandadvocatedforuseintheadolescentpopulation.
They work via several mechanisms of action, but the most important for
providingcontraceptionisestrogen-inducedinhibitionofthemidcyclesurge
of gonadotropin secretion so that ovulation does not occur. Combination
OCPs are potent in this regard, but progestin-only pills are not. Although,
OCPs are widely available and used, they do carry some inherent risks.
Contraindications include previous thromboembolic event, history of an
estrogen-dependent tumor, liver disease, pregnancy, undiagnosed abnormal
uterine bleeding, cerebral vascular or coronary artery disease, women older
than 35 years who smoke heavily (>15 cigarettes/day).
It is imperative that one does not prescribe OCPs to females with undiagnosed vaginal bleeding. The patient may be pregnant in which case the
hormonal therapy may induce bleeding or result in birth anomalies. Also,
breakthrough bleeding is one of the best known side effects of OCPs. This
occurs because the endometrial lining thins, becomes less stable on hormonal therapy (particularly combination estrogen-progesterone therapy),
andbecomesmorepronetobreakdown,withresultantbleeding.Asystematic
workup for abnormal uterine bleeding should be initiated on presentation.
The first two steps of this include a pregnancy test and determining through
history whether the bleeding is ovulatory or anovulatory in nature. Follicle-
stimulating hormone and leuteinizing hormone levels may assist with this
determination.
Some relative contraindications to hormonal contraception include inherited thrombophilias, uncontrolled hypertension, anticonvulsant medications, and migraine headaches (because they may carry an additional risk of
stroke).
Patients must be well apprised of the side effects of oral contraceptive therapy. These include breakthrough bleeding, amenorrhea (5%–10%),
drug interactions (phenobarbital, phenytoin, rifampin), increased cardiovascular morbidity and mortality from stroke and myocardial infarction, venous thromboembolic disease, hypertension, weight gain, nausea, and mood
swings. Over the years, there has been controversy regarding an increased
risk of breast and cervical cancer. There are no data implying a concrete
relationship. Most of these side effects were more prevalent with the older,
high-dose estrogen OCPs. The past 20 years have seen a reduction in both
the estrogen and progestin component of oral contraception. This has led
to a reduction in both side effects and cardiovascular complications. These
preparations can be given cyclically (21 or 24 active, followed by 7 or 4 inactive pills) or by an extended cycle regimen (e.g., 84 active, followed by 7
inactive pills).
Suggested Readings
BrintonLA, DalingJR,Liff JM, etal.Oralcontraceptivesand breastcancerriskamongyounger
women. J Natl Cancer Inst. 1995;87(11):827–835.
Cerel-SuhlSL,YeagerBF.Updateonoralcontraceptivepills.AmFamPhysician.1999;60:2073–
2084.
Felice ME, Feinstein RA, Fisher M, et al. American Academy of Pediatrics, Committee on
Adolescence. Contraception in adolescents. Pediatrics. 1999;104(5 Pt 1):1161–1166.
Book Source Details
- Book Title: Avoiding Common Pediatric Errors
- Author(s): Anthony D Slonim MD, DrPH; Lisa Marcucci MD
- Year of Publication: 2008
- Copyright Details: Avoiding Common Pediatric Errors, Copyright © 2008 Lippincott Williams & Wilkins.
Other Book Chapters Related to Bleeding after sex
Read excerpts from these other book chapters related to Bleeding after sex:
Copyright Details: Avoiding Common Pediatric Errors, Copyright © 2008 Williams & Wilkins.
More About Causes of Bleeding after sex
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More About This Book:
Title: Avoiding Common Pediatric Errors
Authors: Anthony D Slonim MD, DrPH; Lisa Marcucci MD
Publisher: Lippincott Williams & Wilkins
Copyright: 2008
ISBN: 0-7817-7489-6
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» Next page: Provide factor replacement to children with hemophilia who are at risk for bleeding after traumaregardless of their clinical signs and symptoms (Avoiding Common Pediatric Errors)
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