Today's case is not a diagnostic dilemma, but rather a patient education question. A 25 year old woman comes to your clinic because she is interested in starting combined oral contraceptives.Challenge: Which of the following will she need before starting the pill: a breast exam, a pap smear, an STD screen? When should she start taking the pill? What are the contraindications to combined oral contraceptives?
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OCPs
Breast exam, pap smear, and STD screen are not necessary prior to starting OCPs; a careful history, blood pressure measurement, and BMI should be done. Oral contraceptives can be started at any time. Absolute contraindications include previous thromboembolism or stroke, history of an estrogen-dependent tumor, active liver disease, pregnancy, undiagnosed abnormal uterine bleeding, hypertriglyceridemia, and women >35 who smoke heavily. Relative contraindications include poorly controlled hypertension, women on anticonvulsants, women >35 with migraine, and women with migraine with aura.
Source: UpToDate.
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