Contraceptives discontinuation

Headaches Onset or exacerbation of migraine or development of headache with a new pattern which is recurrent, persistent, or severe, requires hormonal contraceptive discontinuation and evaluation. 

Rosenberg M, Waugh M. Oral contraceptive discontinuance a prospective evaluation of frequency and reasons. Am J Obstet Gynecol 1998 179 577-582. 

The incidence of serious known toxicities associated with the use of these drugs is low—far lower than the risks associated with pregnancy. There are a number of reversible changes in intermediary metabolism. Minor adverse effects are frequent, but most are mild and many are transient. Continuing problems may respond to simple changes in pill formulation. Although it is not often necessary to discontinue medication for these reasons, as many as one third of all patients started on oral contraception discontinue use for reasons other than a desire to become pregnant. 

Albendazole can cause serious harm to a developing fetus. Use a barrier contraceptive during the course of therapy and for 1 month after discontinuing the therapy. 

The effects of warfarin may increase when administered with acetaminophen, NSAIDs, beta blockers, disulfiram, isoniazid, chloral hydrate, loop diuretics, aminoglycosides, cimetidine, tetracyclines, and cephalosporins. Oral contraceptives, ascorbic acid, barbiturates, diuretics, and vitamin K decrease the effects of warfarin. Because die effects of warfarin are influenced by many drugp, die patient must notify die nurse or die primary healdi care provider when taking a new drug or discontinuing... 

This drug may cause spontaneous abortion. Women of childbearing age must use a reliable contraceptive If pregnancy is suspected, discontinue use of tiie drug and notify the primary health care provider. Report severe menstrual pain, bleeding, or spotting. 

There is an increased risk of post-operative thromboembolic complications in women taking oral contraceptives Ifposs-bte, use of the drug is discontinued at least 4 weeks before a surgical procedure associated with thromboembolism or during prolonged immobilization. 

B. Discontinue use of the drug and use another type of contraceptive until after your next menstrual period. 

The risk of endometrial cancer among women who have used oral contraceptives for at least 1 year is approximately 40% less than the risk in women who have never used oral contraceptives.9 There is additional evidence to suggest that the benefit of reduced risk for endometrial cancer is detectable within 1 year of use10-12 and that the benefit may persist for years following discontinuation of oral contraceptives.9... 

Table 46-1 illustrates the pathophysiology of amenorrhea relative to the organ system(s) involved, as well as the specific condition that results in amenorrhea. Amenorrhea is also a normal side effect that may result from the use of low-dose oral contraceptives (OCs), extended-cycle OC pill use, or depot medroxyprogesterone acetate use.5 Many women may experience delayed return of menses after discontinuation of OCs. Postpill amenorrhea usually is a self-limited condition. Further evaluation for other unrecognized conditions, such as polycystic ovary syndrome (PCOS), should be considered if spontaneous resolution of the amenorrhea does not occur within 3 to 6 months following discontinuation of the OCs.6,7... 

Toxicities are GI (stomatitis, diarrhea, nausea, vomiting), hematologic (thrombocytopenia, leukopenia), pulmonary (fibrosis, pneumonitis), and hepatic (elevated enzymes, rare cirrhosis). Concomitant folic acid may reduce some adverse effects without loss of efficacy. Liver injury tests (aspartate aminotransferase or alanine aminotransferase) should be monitored periodically, but a liver biopsy is recommended during therapy only in patients with persistently elevated hepatic enzymes. MTX is teratogenic, and patients should use contraception and discontinue the drug if conception is planned. 

Barbieri RL (1997) Reduction in the size of a uterine leiomyoma following discontinuation of an estrogen-progestin contraceptive. Gynecol Obstet Invest 43 276-277... 

In the event of a missed menstrual period If the patient has not adhered to the prescribed regimen, consider the possibility of pregnancy at the time of the first missed period and discontinue the use of the contraceptive vaginal ring if pregnancy is confirmed. 

Elevated blood pressure Elevated blood pressure and hypertension may occur within a few months of beginning use. The prevalence increases with the duration of use and age. Incidence of hypertension may directly correlate with increasing dosages of progestin. Discontinue use if elevated blood pressure occurs. Encourage women with a history of hypertension or hypertension-related diseases during pregnancy, or renal disease to use another method of contraception. 

Must have selected and has committed to using 2 forms of effective contraception simultaneously, at least 1 of which must be a primary form, unless absolute abstinence is the chosen method, or the patient has undergone a hysterectomy. Patients must use 2 forms of effective contraception for at least 1 month prior to initiation of isotretinoin therapy, during isotretinoin therapy, and for 1 month after discontinuing isotretinoin therapy. Counseling about contraception and behaviors associated with an increased risk of pregnancy must be repeated on a monthly basis. 

A 0.5% incidence of migraines has been reported among users of oral contraceptives. Migraine headaches may be a warning signal for an oncoming stroke, and immediate discontinuation of oral contraceptive use is recommended. 

There is some delay in the return of fertility after discontinuation of oral contraceptive use. Gonadotropin profiles should be normal 3 months after combination oral contraceptive use is stopped. The incidence of prolonged amenorrhea extending beyond 6 months is 2 to 3%. This reaction is especially a problem with the use of progestin-only minipills. 

The use of oral contraceptives may interfere with lactation. In addition, the hormones may be present in the mother s milk, hence be taken in by the nursing ctfild. If breast feeding is planned, the use of oral contraceptives should be discontinued until after weaning. 

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