USMLE Forum - Largest USMLE Community

A 25-year-old woman returns to the office because of intermenstrual spotting since beginning oral contraceptive therapy 6 months ago. This is her first attempt at oral contraceptive therapy; she and her partner primarily used condoms for contraception in the past. Before this current therapy her menstrual periods had always been regular. Which of the following is the most appropriate management?

A

) Advise her to take two pills daily until the bleeding stops

B

) Discontinue the oral contraceptive therapy and have her resume use of condoms for birth control

C

) Reassure her that the bleeding problem will resolve in a few months

D

) Switch the current oral contraceptive pill to one containing a higher estrogen dose

E

) Switch to a progestin-only oral contraceptive pill

dd

Because the lower doses of estrogen in OCPs are insufficient to sustain endometrial integrity, abnormal uterine bleeding has become more common.11 The most frequent cause of breakthrough bleeding with OCPs is progestin-induced decidualization and endometrial atrophy, which result in menstrual breakdown and irregular bleeding

After three months and if other causes of bleeding (including pregnancy) are excluded, treatment with supplemental estrogen and/or a nonsteroidal anti-inflammatory drug (NSAID) often alleviates the bleeding (Table 4).18,21 Adding extra estrogen while maintaining the same dose of progestin increases endometrial thickness, thereby stabilizing the endometrium and blood vessels.

so answer is D

D...

CC