Monday, May 17, 2010


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?

Image of OCPs is from Wikipedia, shown under GNU Free Documentation License.

1 comment:

Craig Chen said...


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.